Pioneering Fertility Sparing Surgery: The Study That Changed Myomectomy

Today, if a woman needs a fibroid removed (myomectomy) to improve her fertility, she expects a minimally invasive procedure. She expects small incisions, a short recovery, and a strong uterus capable of carrying a baby.

But in the late 1990s, this was not the standard. It was a risk. At that time, the medical establishment believed that Laparoscopic Myomectomy was dangerous for women who wanted to conceive. The prevailing fear was that stitching the uterus through small keyhole incisions would not be strong enough to withstand the pressure of labor, leading to catastrophic Uterine Rupture.

Women were told that if they wanted a baby, they had to endure a Laparotomy (a large, open abdominal incision) with its painful recovery and high risk of scar tissue—or risk losing their pregnancy.

In 1999, Dr. Andrea Vidali, working alongside the legendary Dr. Harry Reich, proved the establishment wrong.

The Collaboration: Vidali & Reich

Dr. Andrea Vidali was not just an observer of surgical history; he was writing it. He was working in collaboration with Dr. Harry Reich, the surgeon credited with performing the world’s first laparoscopic hysterectomy. Together, they sought to push the boundaries of what could be done through a scope.

Their goal was simple but radical: Prove that you could remove large, complex fibroids through tiny incisions without compromising the strength of the uterus or the safety of a future pregnancy.

The 1999 Breakthrough

Published in the prestigious journal Fertility and Sterility, their study, “Laparoscopic Myomectomy: A Comprehensive Review of a Series of Infertile Women,” became a foundational text in modern gynecology.

Unlike previous small case reports, this was a robust series involving infertile patients with large fibroids (often >5 cm) and deep intramural disease. The results silenced the skeptics:

• Pregnancy Success: The study reported a 64.3% pregnancy rate post-surgery, a staggering success for an infertile population.

• Safety Confirmed: Crucially, there were zero cases of uterine rupture during subsequent pregnancies or labor.

From Myomectomy to AdenoDue

Dr. Vidali has spent the last 25 years refining the principles he helped establish in 1999. Just as he fought to prove that fibroids could be treated safely without open surgery, he is now leading the charge on Adenomyosis—a condition many doctors still treat with hysterectomy.

At ESSI, Dr. Vidali applies that same spirit of “impossible” innovation with AdenoDue. This signature procedure combines laparoscopic excision (removing endometriosis) with ultrasound-guided precision (ablation or resection of adenomyosis) in a single surgery. Just like the 1999 study, AdenoDue proves that you can treat deep disease in the uterine wall while protecting the organ’s integrity for future pregnancy.

He is still doing what he did with Dr. Reich in the 90s: protecting the reproductive future of women when others say it cannot be done.

The Original Research

Title: Laparoscopic myomectomy: a comprehensive review of a comprehensive series of infertile women Journal: Fertility and Sterility, Volume 70, Issue 3, Supplement 1, Page S15, 1998 (Published 1999) Link: Read the Abstract on ScienceDirect

Summary: A retrospective analysis of laparoscopic myomectomy in infertile women with large uterine fibroids. The study demonstrated that laparoscopic repair of the myometrium is safe, effective, and yields high pregnancy rates without increasing the risk of uterine rupture, validating the laparoscopic approach as a standard of care for fertility patients.