Laparoscopic Myomectomy

What Is Laparoscopic Myomectomy?

During a laparoscopic surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. The camera and the instruments are then introduced through the ports, which allow access to the inside of the patient. The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon’s eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure.

Laparoscopic myomectomy is when a small scissors-like instrument is used to open the thin covering of the uterus. The fibroid is found underneath this covering, grasped, and freed from its attachments to the normal uterine muscle. After the fibroid is removed from the uterus, it must be brought out of abdominal cavity. The fibroid is cut into small pieces with a special instrument called a morcellator, and the pieces are removed through one of the small incisions. The openings in the uterus are then sutured closed using specially designed laparoscopic suture holders and grasping instruments.

Why is it done?

Your doctor might recommend myomectomy for troublesome fibroids if:

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

What to expect after surgery?

Following laparoscopic myomectomy, most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be a good idea. Medical staff members urge you to walk around as soon as you're able, because walking reduces the risk of many postoperative complications. You may have to avoid certain activities, such as driving, lifting heavy objects, climbing stairs or exercising vigorously until you recover. Also, your doctor may advise that you not use tampons or have sexual intercourse for up to six weeks. You can expect some vaginal drainage for up to six weeks as well.

What are the risks of the surgery?

  • Excessive blood loss
  • Scar tissue – Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery.
  • Development of new fibroids - Myomectomy doesn't eliminate your risk of developing more fibroids later.
  • Childbirth complications - Having had myomectomy surgery can pose some risk factors for delivery if you become pregnant.
  • Inability to restore the structure of the uterus - To remove embedded fibroids, the surgeon might cut into the muscular wall (myometrium), leaving a gap. Closing it requires stitches, usually in layers. Rarely, the surgeon must remove the uterus if bleeding is severe or if he or she can't reconstruct the uterus.

What are the alternatives to the surgery?

There are not any currently available medicines that will permanently shrink fibroids. Often heavy bleeding can be decreased with birth control pills. There are a number of medications in the family of GnRH agonists, which induce a temporary chemical menopause. In the absence of estrogen myomas usually decrease in size. Unfortunately, the effect is temporary, and the fibroids rapidly go back to their pre-treatment size when the medication is discontinued.