Laparoscopic Myomectomy Instruments: Building the Set

The five groups of a myomectomy set

Start with access: a 10 mm or 5 mm laparoscope, trocars and a light cable. Then list the instruments for enucleation and handling, the energy sources for incision and haemostasis, the suturing tools for uterine repair and finally the removal system for the specimen.

Surgeons differ in preference, so work from a written list agreed with the lead surgeon and the theatre nurse manager. A consistent set reduces the time needed for set-up and for counting.

Remember that a myomectomy can change in the course of the operation. Keep a back-up tray with an additional trocar, a larger grasper, alternative energy and extra suture within reach, so that the team does not have to open a new set mid-procedure.

• Access: laparoscope, trocars, light cable
• Handling: grasper, myoma screw, scissors, needle holder
• Energy: monopolar hook or scissors, bipolar forceps, vessel sealer
• Suturing: needle holders, barbed suture, knot pusher
• Removal: morcellator and containment bag, or retrieval bag

Access and handling instruments

Modular reusable instruments let you replace worn parts without discarding the whole device. REDA's laparoscopy range includes autoclavable 5 and 10 mm laparoscopes, 0 and 30 degrees, trocar sleeves from 3.5 to 20 mm and modular hand instruments with a CLICK snap-action coupling, carbon handles with ratchet, 360 degree rotation and an HF connector.

The myoma screw, also called a corkscrew, fixes the fibroid for traction during enucleation. Check the thread, shaft length and compatibility with the trocar. Atraumatic graspers and a suction-irrigation set complete the handling group.

Energy for incision and haemostasis

Myomectomy needs controlled cutting through the uterine wall and reliable haemostasis in the bed. Monopolar and bipolar instruments are used, with the generator chosen to support both. See our overview of the vessel sealing options for BOWA ERGOseal and ARC 400.

Confirm that your generator provides appropriate settings and that cables and handles are compatible with your reusable instruments.

Suturing and uterine repair

Laparoscopic suturing of the myometrium is the technical core of the procedure. Choose needle holders with a comfortable grip and secure jaws, and decide whether you will use barbed suture, which avoids knot tying, or conventional suture. Suture materials are consumables, so plan stock with your pharmacy or purchasing office.

Training and simulation shorten the learning curve. Make sure the team has the same instruments at the trainer as in theatre.

Finally, agree how the set is stored and reprocessed: standardised trays and rigid containers reduce missing items and speed turnaround between cases, which matters on busy gynaecology lists.

Specimen removal and contained morcellation

The removal system deserves separate analysis. The NOUVAG morcellation set pairs the TCM 3000 BL control unit with 12 mm and 15 mm instruments for laparoscopic hysterectomy and myoma enucleation, and BOWA's MetraBag pro enables morcellation in a sealed 3.5-litre bag inserted via a 10 mm trocar.

Many hospitals now use contained morcellation: see contained morcellation explained. For the broader NOUVAG range, visit the NOUVAG brand page. Beckfinity can help you assemble a complete myomectomy set; please request a quote or consultation.