Laparoscopic Uterine Myomectomy

Laparoscopic Uterine Myomectomy

Leiomyomas are the most common benign tumors in women of reproductive age, and laparoscopic myomectomy has proven its efficiency over other methods of treating these tumors in Turkey.

The uterus is one of the most common places for cancers to arise, whether healthy or malignant. Therefore, surgical methods and drug combinations have varied, and many qualitative leaps have emerged in the treatment of diseases of this organ, especially because of its important function in carrying embryos and preserving the human species.

What is leiomyomas?

Leiomyoma is a benign tumor in the thick middle layer of the uterine wall, which is the muscular layer (it arises at the expense of the uterine muscles) that contract during labor and menstruation, and it often appears during the reproductive years of women.
It is very rare for these tumors to develop into malignant tumors, but in some cases (30% of cases) they can cause many symptoms in patients.
This tumor is one of the most common tumors among the benign uterine tumors that are the most seen in women.
These tumors vary greatly in size and a patient may have more than one tumor in different areas of the myometrium.
These tumors increase the risk of miscarriage or spontaneous abortion in patients and may cause infertility in them.
This tumor is also called a Fibroid, which is a more general term that includes fibroid and muscle tumors that typically arise in the uterine wall, so this operation can be called laparoscopic uterine fibroid removal.

What surgeries are usually performed to remove uterine myoma?

Usually Uterine myoma surgery (or eradication of fibroids) is calledMyomectomy.
There are several ways in which this surgery can be performed:
  • Open Abdominal Myomectomy: In this method the doctor makes a surgical incision in the lower abdomen (the incision is often horizontal) to reach the uterus and remove the tumor.
  • Laparoscopic Myomectomy: Which we will talk about in detail later in the article.
  • Robotic myomectomy: Much like laparoscopic myomectomy, the doctor here sits further away from the patient and controls robotic instruments via a remote control tool, allowing greater access to the tumor and a clearer view.
  • Uterine myomectomy via Hysteroscopy : The doctor removes the tumor by inserting a probe (along with other medical instruments) into the vagina and through the cervix until it reaches the site of the tumor.

In Turkey, there are several other non-surgical treatments for this tumor with high efficiency, such as Catheter treatment of fibroids..

A picture of the different surgical incisions through which the uterine myoma can be removed
In this picture, we see that the traditional open surgery depends on larger surgical incisions, and therefore the tissue loss will be greater and the recovery period is greater

When do we do laparoscopic hysterectomy instead of other methods?

Laparoscopic surgery has several advantages over other methods, including:
  • Pain and blood loss is less and usually controlled.
  • Much fewer aesthetic problems compared to the use of open surgery method.
  • Fewer adhesions.
  • Faster recovery after surgery compared to other methods.
  • The patient does not need to stay in the hospital for more than one night.
However, laparoscopic uterine myomectomy cannot be used in all cases, as there are conditions that must be met in order for this surgery to achieve the best results, so it is required that:
  • The uterus should have good mobility that allows maneuverability.
  • The diameter of the tumor should not exceed a maximum of 10 cm (of course there are exceptions that depend on the case and the patient).
  • There should be no more than 5 fibroids.
  • There is a sufficient surgical field for the surgical operation, and that the tumor is not too deep, so it is impossible to eradicate.

Who are the candidates for Laparoscopic Myomectomy?

Any patient who has symptoms due to the presence of these tumors or the tumor has caused her to have many previous miscarriages or affected her daily and sexual activity is a candidate for Laparoscopic Myomectomy.
Laparoscopic myomectomy is also suitable for patients who want to have children in the future or who do not want to remove the uterus completely (as happens in many treatment solutions) for other reasons.
Symptoms of women with these tumors may include:
  • Severe pelvic or abdominal pain that does not go away on its own
  • Bleeding outside menstruation
  • Troubled menstrual cycle (longer or shorter)
  • Difficulty urinating or incontinence in some cases
  • unexplained anemia

Preparations before the operation

In the event that a decision is made to perform the operation, the patient must consult the surgeon before the operation, to inform her of the necessary preparations.
The doctor must be informed of the type of medications the patient is taking, whatever they are (vitamins, supportive drugs...) and the doctor is the one who determines which medications should be discontinued.
The patient is told to stop eating and drinking hours before the operation (usually at midnight on the night of the operation).
Medications such as Gonadotropin-releasing Hormone Agonists may be given to reduce the size of the patient's tumor.
Iron-boosting drugs can also be given to the patient to prevent heavy bleeding and treat anemia.
Various tests are performed to determine whether the patient is ready for surgery, including:
  • Sonography of the Abdomen
  •  MRI
  • Various Blood Tests
  • ECG

How is a Laparoscopic Uterine Myomectomy performed?

The operation can be performed under general anesthesia for the patient or only for the abdominal area, depending on the duration of the operation, the patient’s desire and several other factors, but in most cases, general anesthesia is preferred.
First, four small incisions about one centimeter (or half an inch) in diameter are made in the lower abdomen.
These incisions are distributed, one near the navel, the other near the pubic hair, and one incision near each hip.
The abdominal cavity is then filled with Co2 gas to help the surgeon see inside the abdomen.
The doctor inserts the laparoscope through the umbilical hole, a thin tube that ends with a light and a camera (called a laparoscope), through one of the incisions where the laparoscope allows viewing of the ovaries, fallopian tubes and uterus.
In the event that the tumors are large in size, a specific tool is used to cut the tumors called the morcellator, where this device cuts the uterine myoma into small pieces (appropriate to the size of the incisions made) that the doctor can remove using medical tools inserted through the other incisions.
The uterine muscle is sutured where the tumor was removed, and at the end of the procedure, the injected gas is released and the incisions are sutured.
The process usually takes less than three hours.
The doctor may change the course of the surgery to Open Abdominal Myomectomy if the tumor is difficult to remove and the operation is prolonged.

In the robotic myomectomy surgery, the same steps are taken, except that the doctor controls a robotic hand remotely to alternate his place in the procedure.

A picture of a laparoscopic uterine myomectomy
Laparoscopic hysterectomy in Istanbul is performed quickly and efficiently, and the patient does not need to stay in the hospital more than one or two days.

If it is difficult for you to understand the steps of the process or you want to ask about its cost, do not hesitate to Contact us, Bimaristan center is your family is in Turkey.

Complications and Taking Care after the Operation

As in any minimally invasive operation, laparoscopic myomectomy has several complications, although it is rare, and these complications include:
  • Incision site infection
  • Anesthetic problems caused by the drug not matching to the patient's body
  • Heavy bleeding (very rare due to the minimally invasive surgery and small incisions)
  • Clots forming after the operation
  • Damage to nearby organs inside the abdomen
  • Not removing the tumor completely, which leads to its growth again and the return of symptoms in the patient

    A picture of the surgical scars after laparoscopic uterine myomectomy and the extent of the effect of these scars on the aesthetic aspect
    Sutures are usually used to close the incisions, which often disappear after several weeks

As we have seen, the complications of a laparoscopic myomectomy are rare and are nothing more than the least complicated operation.
As for recovery, the patient usually does not stay in the hospital for more than one night.
The patient recovers from surgery after two or three weeks at most.
The patient will feel some pain and it is possible that she will have intermittent light vaginal bleeding, and for this the doctor will give pain relievers to improve the patient’s condition and psychological state.
The patient must wait for two or three weeks before engaging in some strenuous work or sexual intercourse, to avoid bleeding or rupture of the surgical sutures.

Sources:

  1. BCM
  2. Weillcornell
  3. London-Firoids

Common Questions

Laparoscopic myomectomy carries much less risk and complications than the open method of surgery, and its risk does not exceed the risk of the usual operation.

The duration of the hysterectomy operation does not exceed 3 hours at most.

The uterine myoma has several causes and it can recur after excision, either because it was not completely removed, or there is another cause that we have to treat.

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