Myomectomy is a surgical procedure to remove fibroids from uterus. Fibroids are common noncancerous tumors that appear in the uterus. Myomectomy can be done through abdominal route, laparoscopically or hysteroscopically depending on size and position of fibroids. Laparoscopic myomectomy is performing myomectomy through key hole incision. The goal of surgery during myomectomy is to take out symptom-causing fibroids and reconstitute the uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy removes only the fibroids and leaves your uterus.

INDICATIONS OF MYOMECTOMY

Your doctor might advise myomectomy for fibroids causing symptoms that are troublesome . If you need surgery, reasons to choose a myomectomy over a hysterectomy for uterine fibroids include:

• You want to bear children
• Your doctor suspects fibroids might be interfering with your fertility
• You want to retain your uterus

TYPES OF MYOMECTOMY

Several surgical techniques are used to remove the fibroid from the uterus. The choice of the technique depends on various factors such as the position and size of the fibroids as well as the characteristics of the patient.Various types of Myomectomy are as described under –

• Laparoscopic Myomectomy is a procedure to remove the fibroids present in the uterus. This technique is performed using a narrow telescope like an instrument used to see inside the abdomen. The procedure involves small 3 to 4 incisions in the navel and lower abdomen. Fibroids are enucleated from the uterus repairing the uterus incision. Recovery time is around 2 to 3 weeks and requires one night of the hospitalization. Complications such as the bleeding, injury to internal organs, an infection might occur during this procedure which is minimal.
• Abdominal Myomectomy, is performed using a horizontal or vertical incision in the abdominal wall. It enables the surgeon to have direct access to the patient’s uterus and usage of traditional surgical techniques and instruments is done. Anesthesia is given to the patient and a full recovery is expected within the 4 to 6 weeks.
• Hysteroscopic Myomectomy allows removing a submucosal fibroid from the inside wall of the uterus. A narrow telescope-like instrument is passed through the vaginal route to visualize the uterine cavity in order to allow surgery inside the uterus. This procedure is only performed for the smaller fibroid. This procedure is performed under the anesthesia in an operating room. Some of the complication faced during this procedure includes fluid overload, bleeding, the formation of the scarring inside the uterus, and uterine perforation.

HOW IS LAPAROSCOPIC MYOMECTOMY PERFORMED?

The procedure is performed under the anesthesia. The operating surgeon makes four small incisions. These incisions are of about half an inch long each into the lower abdomen. The abdomen is filled with carbon dioxide gas so that the surgeon can see inside the abdomen. A laparoscope is placed into one of the incisions by the surgeon. A laparoscope is basically a illuminated narrow tube with the camera attached on one end. On the other incision, the small instruments are placed.

To remove the fibroids from the uterus, the surgeon will cut the fibroids into the small pieces. The fibroids are pushed out of the vagina or through the small openings into the abdomen. Once the fibroids are removed, the surgeon will reshuffle the instruments, release the gas and close the incisions. If the fibroids are too big, abdominal myomectomy treatment is used where a large incision is made in the abdomen to remove the fibroids.

AFTER THE PROCEDURE OF LAPAROSCOPIC MYOMECTOMY

Patient usually has to stay for around a day in the hospital after the procedure is done. Usually, doctors prescribe oral pain relief medications after the surgery and give instruction on the diet and activities. Women can expect staining and vaginal spotting for a couple of days up to six weeks depending on the type of procedure done. Laparoscopic Myomectomy is a less invasive procedure in which women have less pain, lose less blood, and can return to the normal activity more quickly as compared to other treatments such as laparotomy.

BENEFITS OF LAPAROSCOPIC MYOMECTOMY

Compared to other types of myomectomy, Laparoscopic Myomectomy is considered as an effective and safe procedure to remove fibroids from the uterus. Some of the benefits are as follows –

• It causes less loss of blood during the procedure.
• This type of treatment does not take a long time and the patient gets a discharge within a day.
• Postoperative recovery is quicker

RISKS OF LAPAROSCOPIC MYOMECTOMY

Laparoscopic myomectomy has the low complication rate. Still, the procedure poses a unique set of the challenges. Risks include:

Excessive blood loss. Many women with uterine fibroids already have low haemoglobin (anaemia) due to heavy bleeding during periods, so they’re at a higher risk of complications due to blood loss. Your doctor may suggest ways to build up your haemoglobin before surgery.

During the procedure surgeons take extra measures to avoid excessive bleeding. These may include blocking blood flow from the uterine blood vessels by using tourniquets and clamps and injecting medications around fibroids to cause blood vessels to constrict. However, most steps don’t decrease the risk of needing a transfusion.