Dr. Preeti Tandon
(Specialist Obstetrics & Gynaecology Laparoscopic & Robotic Surgeon. )

MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG
Diploma in Adv Gynae Endoscopy (France), Certified Robotic Surgery Training (USA).

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Laparscopic Myomectomy

Myomectomy is a surgical procedure used by surgeons to remove uterine fibroids, also referred as leiomyomas. These fibroids grow in the uterus, usually during the course of childbearing, but they can appear at any age. The main goal of a surgeon during the course of myomectomy is to cut the main symptom fibroids and reconstruct uterus to the desired healthy state. Differ from the process of hysterectomy, in which entire uterus is removed, a myomectomy involved the removal of fibroids.

Women who undergo the procedure of myomectomy report improvement in fibroid symptoms, including the distorted menstrual cycle with heavy bleeding and pelvic pressure as well.

Myomectomy is highly recommended for the removal of fibroids and its causing symptoms that create trouble or interfere with the normal routine. The substantial reasons to opt for the myomectomy in place of hysterectomy for uterine fibroids are:

  • You are planning to bear children .
  • Your surgeon finds that uterine fibroids may affect your fertility.
  • You want to keep your uterus, for whatever the reasons.

What is best treatment option available and which one is optimal as per the problem.?

Upto the numbers of 75 % of aged women going under the reproductive age may develop uterine fibroids during this course, but women who experience the real symptoms and complications are less than 30 %. Available treatments for the symptomatic fibroids are depend upon the complications someone is going through. It ranges from medications, like – Hormones and some pain relievers, like – oral contraceptives, to minimally invasive procedures like uterine artery embolization, HIFU to surgeries such as myomectomy or hysterectomy.

What you can expect
It is entirely depends on the size, number and the precise location of fibroids. Your surgeon may choose one of the surgical procedure optimal for your complication.

Abdominal myomectomy
In the surgical procedure of myomectomy, a gynecologist go through an open and precise incision to reach to the uterus and remove the fibroids. Usually, a surgeon enters into pelvic cavity through one of two incisions:

  • A horizontal bikini-line incision - this incision is about an inch above the pubic bone. This sort of incision follows the path of natural skin lines and causes very less pain in comparison to the vertical incision. It causes less pain as it is resulted in thinner scar. Its length depend on the complication, usually, it is 3 to 4 inch, but many be longer than that. Some surgeons find this can limit their access to the pelvic cavity, so it is not recommendable for the large fibroids.
  • A vertical incision - this incision is performed in the middle of the abdomen and extend to the navel to slightly above the pubic bone. This sort of incision enable surgeons to largely access to a uterus than horizontal incision. This involves less blood less but less used, unless the uterus is large in size to past one’s navel.

Minimal Invasive Surgery

Laparoscopic or Robotic myomectomy
In laparoscopic or robotic myomectomy procedure, the surgeon accesses through small incisions in abdomen and removes fibroids.

  • Laparoscopic myomectomy. this procedure involves a small incision of a cm size near the areas of bellybutton. Then a laparoscope – a tube with the camera into the abdomen area. Then the concerned surgeon with the suitable instruments inserted through the 5 mm small incisions in the abdominal wall.
  • Robotic myomectomy. this process relies on the same procedure to laparoscopic myomectomy through small incisions. In this process, concerned surgeon controls the movement of instruments from a separate console.

In many procedures, the fibroid is cut into some small pieces and removed from the abdominal wall through small incisions. Otherwise, the fibroid removed through mini-laparotomy incision from the abdomen, so that it can be removed without being cut into pieces. In some of rare cases, the fibroid removed through making an incision in the vagina.

Procedures of Laparoscopic and robotic surgery use precise and smaller incisions than the procedures of abdominal and myomectomy use. This resulted in less pain, less loss of blood and the recovery time to reach to the normal routine is also very less.

Hysteroscopic myomectomy
This procedure is used to treat fibroids that budge into the cavity of uterine, also referred as submucosal fibroids. In this case, Hysteroscopic myomectomy is highly recommended by the surgeons. This procedure involves access and removal of fibroids by using instruments inserted through vagina and cervix.

In rare case, your surgeon many go through laparoscopic inserted through a small incision in your abdomen area to view pelvic organs and monitor the outside of the uterus during a complicated Hysteroscopic myomectomy.

After the procedure
A patient can experience some vaginal spots or stains after the procedure. It can be extended to six weeks of time and depend upon the procedure one gone through. One should refrain from pregnancy upto the course of 3 months, as this period is required to heal the uterus.

Why should one opt for the minimally invasive procedures instead of a traditional surgery.?

In most of the cases, minimally invasive procedures have many significant attributes over traditional surgery. These include – fewer traumas during the course of surgery and aftermath of it as well. Opting for Minimally invasive procedures shorter your stay and ensures a fast recovery as well.