Laparoscopic Fibroid Removal Surgery (Myomectomy)
Myomectomy it the treatment of choice for women who have symptomatic fibroids but cannot or do not want to opt for a hysterectomy. Myomectomy, like any other gynecological surgery, can be performed either by laparoscopy or by open abdominal surgery. Laparoscopic myomectomy has many advantages when compared to open abdominal surgery-
- Fast recovery
- Shorter hospital stay
- Less blood loss
- Cosmetically improved scar
- Less infection rate
- Comparable pregnancy rates
Can Laparoscopic fibroid removal be done in all women with fibroids?
Myomectomy can be performed by a hysteroscope or laparoscope depending on the location of the fibroid.
- Hysteroscopic myomectomy: This route works best for small submucous fibroids (indenting on the cavity of uterus). The fibroid can be resected through a trans-cervical approach using a hysteroscope. This is usually a day care procedure and doesn’t require hospital stay and quick recovery.
- Laparoscopic myomectomy: This route is reserved for larger fibroids close to the outer surface of uterus. A small cut is made inside your belly and a thin tube with light and camera system is inserted. This laparoscope is used to see and treat your fibroids in the same sitting. Fibroids are removed completely either through vagina or with the help of a morcellator which churns the fibroid into small chunks that are easy to remove from the small cuts on your belly. Once the procedure is complete, the cuts on your belly are stitched back.
What preoperative tests are required before myomectomy?
A complete history and thorough medical examination is the key to success before any surgery. Routine blood investigations, chest X-Ray, ECG and ultrasound are sufficient in most of the cases but rarely some may require MRI scan when the location and nature of fibroid is dubious.
How many cuts are made in laparoscopic surgery?
Generally 3 or 4 small cuts are made on your belly depending on the size, number and location of fibroids.. One 10 mm incision is made for entry of laparoscope and rest are 5mm cuts for other small instruments.
How are the fibroids removed through such small incisions in laparoscopy surgery?
As discussed above, an instrument called morcellator is used to churn the fibroid into smaller pieces, which are then easily extracted out through the same cut in belly.
What is the outcome on future pregnancies?
Laparoscopic myomectomy is a safe procedure and it significantly increases the chances of becoming pregnant in women where fibroid is the reason for infertility. It has no negative effect on future pregnancy outcomes and the baby.
What to expect after laparoscopic myomectomy?
You will require a short hospital stay for about 24-48 hours depending on how your surgery went and how well you recover. Your doctor will give you some antibiotics to combat infection and some painkillers immediately after the surgery. Some amount of vaginal bleeding and shoulder pain is normally seen after the procedure. The effect of anaesthesia will last fir around 6 hours after which you will be allowed clear liquids and full meals gradually over time.
For the first few days after discharge, you may require regular painkillers. You should avoid heavy weight lifting and refrain from sex for 6 weeks. You can resume your daily routine gradually with adequate amount of rest in between. The first post operative visit is scheduled after one week of surgery for review and suture removal.
Q1. Is laparoscopic myomectomy major surgery?
Ans. Yes, laparoscopic myomectomy is a major surgery as it involves the removal of your fibroids. But the difference between conventional open surgery and laparoscopy is that laparoscopy is a minimally invasive surgery that has a speedy recovery and minimal post-op complications.
Q2. How long does laparoscopic myomectomy take?
Ans. The operative time can vary from half an hour to a couple of hours depending on the size and site of fibroid. In laparoscopy, larger fibroids are removed as shreds of tissue from small cuts in your belly. This is called morcellation and requires the help of an instrument called morcellator.
Q3. Is laparoscopic myomectomy safe?
Ans. Yes. Laparoscopic fibroid removal surgery is absolutely safe procedure in experienced hands. It has extremely good results with low failure rate. It carries minimal risk of associated complications depending on the size and location of the fibroid. Complications including bleeding, injury to bowel and bladder, uretric injury and infection have been seen very rarely.
Q4. Can large fibroids be removed laparoscopically?
Ans. Yes. Large fibroids can be easily removed via laparoscopic route. Laparoscopic surgery gives a clear and magnified image of the operative site, which helps in minimizing the complications associated with the surgery.
Q5. How long does it take to recover from fibroid surgery?
Ans. Laparoscopic surgery is well known for its faster recovery and shorter hospital stay. You are discharged the very next day of surgery and are free to move around. Your stitches are removed after 7 days and you can resume light household activites by the end of one week.
Q6. What size fibroids need surgery?
Ans. Any fibroid which is causing symptoms either in form of heavy bleeding or pain or infertility should be considered for removal. The location and size of the fibroid have to be taken into account before planning surgery. Experts believe that for laparoscopic removal of fibroid, maximal size should be 8 cm to 10 cm and total number of fibroids should not exceed four.
Q7. What are the side effects of fibroid surgery?
Ans. Fibroid surgery is generally safe. Rarely, complications like bleeding, injury to viscera, infection can be encountered in large fibroids and broad ligament fibroids.