Laparoscopic Myomectomy - Removal of Fibroids

Laparoscopic Myomectomy

Laparoscopic Myomectomy is the surgical removal of fibroids from the uterus through a small keyhole incision done using Laparoscope. Ideally done in unmarried women, married women without children, women willing to retain the uterus.

In this procedure, only the fibroid is removed by making a small incision on the fibroid and taking it out by the morcellator. Fibroids are a benign (not harmful) disease of the uterus.

Myomectomy - treatment of fibroids in chennai -dr deepa ganesh

Distribution of (different types of) Fibroids:

0
%
Intramural
0
%
Submucous
0
%
Subserous and Broad ligament & cervical

Causes of Fibroids:

  • Genetic: Chromosomal abnormalities
  • Age: 20% incidence > 20 yrs40% incidence >40 yrs
  • Race: Common in African families
  • Hormonal: Hyperoestrogenism

High risk factors for Fibroids:

  • Obesity
  • Diabetes

  • Hypertension
  • H/O Polycystic Ovaries

Symptoms of fibroids

  1. Menstrual Disturbances, the most common symptom of FIBROID. 50% Fibroids are asymptomatic. Women may have a single symptom or present with several complaints depending upon the number, size, and location of tumors. There is progressive menorrhagia (Regularly timed episodes of bleeding that are excessive in amount > 80ml and/or duration of flow > 5days, Polymennorhoea (Frequent & regularly timed episodes of bleeding occurring at intervals of 21 days or less) occurs when cystic ovaries & Pelvic infection coexist. Metrorrhagia (Inter-menstrual bleeding ) is common with submucous fibroid.
  2. Infertility
  3. Pain
  4. Abdominal Lump

Diagnosis of fibroids

  1. The most common diagnostic test carried out to ascertain fibroid is Ultrasound. Ultrasound shows Fibroid as a well-defined mass.

  2. CT/MRI to confirm the diagnosis. It can differentiate from other conditions like adenomyosis, ovarian tumor, ectopic and adnexal mass. It shows the exact location, size, and number of fibroids.

  3. An intravenous pyelogram is required in broad ligament fibroid to check the anatomy and pathology of the ureter.

  4. Blood investigations like hemoglobin to ascertain the degree of anemia, blood group& Rh typing.
  5. Hysterosonography – Done in women who want to become pregnant and suffering from sub-mucosal fibroids. Sterlie saline is injected to expand the uterine cavity and the images of the fibroids are taken. This is also called Saline Infusion Sonogram.
  6. Hysterosalpingography – This imaging method uses a gel/dye (injected into the uterus) to highlight the uterine cavity and the fallopian tubes on the x-ray images.
  7. Hysteroscopy – A small telescope kind of instrument with light at the end is inserted into the uterus. Then saline is injected to examine the walls of the uterus and the fallopian tubes.

Treatment of fibroids

Fibroids are benign, meaning non-cancerous. As long as the fibroids are not showing any symptoms, most gynecologists will ask you to wait and be cautious of any physical changes or menstrual changes happening in your body. Surgery for fibroids is always taken as the last option when medications are barely helpful.

Treatment of fibroids using medicines:

  1. GnRH, Gonadotrophin Releasing Hormone agonists. This blocks the production of estrogen and progesterone. Reduced levels of these hormones will temporarily stop menstruation (person will feel like menopausal time). As a result of reduction of these hormone production, the fibroids shrink and also the blood levels of the person will improve.  Similar to menopausal symptoms, the person will experience hot flashes, dryness of vagina etc.
  2. IUD to release progestin – Intra Uterine Device is placed inside the uterine cavity that releases progestin. This device helps in reducing the heavy menstrual bleeding but does not help in treating the fibroids.
  3. Tranexamic Acid – This is taken only during heavy bleeding time.The non hormonal medicine helps by reducing the amount of bleeding during menstruation.
  4. Other medications are also available to help alleviate symptoms but they don’t actually treat the fibroids. As said, a good gynecologist will only opt for a surgery only if it is absolute necessary.

FAQs on Fibroids Treatment

How is a treatment option selected?

Small and asymptomatic fibroids don’t require removal. They have to be observed every 6 months or medically managed.


Surgical Rx:

Traditionally all the surgical procedures are done by a bigger incision but we operate it through small keyhole incisions of less than 5 mm incision on the abdomen.


Indications for Surgical Rx:

  1. Symptomatic fibroids.
  2. Rapidly growing fibroid.
  3. Fibroid causing infertility.
  4. Fibroid causing pressure symptoms.

 

Visit our Frequently Asked Questions on laparoscopic treatment section to know what you should do before, on the day and after laparoscopic procedure.

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