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Fibroid Removal -
Laparoscopic / Hysteroscopic Myomectomy
Many women have benign tumors in their uterus called myomata uteri or fibroids. These myoma may be silently present and cause no problems. In many women, however, fibroids can cause excessive and frequent menstrual periods, pelvic pain, infertility, and recurrent pregnancy loss.
Severe anemia can result from excessive uterine bleeding. Other symptoms can include pelvic pressure on the woman's bladder or rectum which may result in frequent urination or constipation. Some women will experience pain during sexual intercourse (due to an enlarged uterus).
Benefits
Laparoscopy and hysteroscopy are two approaches for removing fibroids (myomectomy). Until recently, surgical removal of fibroids almost always involved a large abdominal incision (laparotomy) with a three-to-five day hospital stay and six-to-eight week recovery.
The advantages of laparoscopic/hysteroscopic myomectomy are a shorter hospital stay (one day), reduced recovery time and reduced post-operative pain, smaller incisions, better cosmetic results, and a lower cost.
Risks
While most laparoscopic/hysteroscopic myomectomies proceed without difficulty, there is always the possibility that a more conventional incision in the abdomen may be necessary to safely complete the surgical procedure. As with any other surgical procedure, there are also risks of bleeding, blood transfusion, infection, anesthetic complications, or injury to other structures such as bowel or bladder. You are also at risk for intrauterine scar tissue if the fibroid is in the cavity. Women who later become pregnant may need a Caesarean Section for delivery because of weakening of the uterine wall from the myomectomy. And finally, fibroids may recur after a myomectomy.
Procedure
Laparoscopic myomectomy takes place under general anesthesia or a regional (epidural) anesthesia. Several small 1/2 inch incisions are made in the abdominal wall to place the laparoscope and other instruments. Then, using techniques such as coagulation or electrosurgery, the fibroids are removed and the uterine wall repaired. We use a bipolar needle or laser to perform "myolysis" of the fibroids. This does not involve surgically cutting into the uterus, but instead, it uses either electrical current or laser energy to coagulate the fibroids, which shrink to about half the size after surgery.
Hysteroscopic myomectomy is performed through the woman's cervical canal and does not involved any abdominal incisions. A device called a resectoscope cuts away the fibroids or an electrical current "evaporates" the fibroids.
After a laparoscopic or hysteroscopic myomectomy,
the patient goes home the same day. Most women are back to normal
activities within 7-10 days.
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