Laparoscopic Myomectomy

Laparoscopic Myomectomy

A myomectomy is a surgical procedure used to remove non-cancerous growths, also called uterine fibroids or leiomyomas, that are found growing in the uterus of women who are of childbearing age.

Types of uterine fibroids: submucosal, subserosal, intramural, and cervical
Types of uterine fibroids: submucosal, subserosal, intramural, and cervical

What Is a Laparoscopic Myomectomy?

Depending on the size, number, and location of the fibroids, the myomectomy can be performed using one of several techniques. Laparoscopic myomectomy is one of these techniques and is considered minimally invasive, has a shorter recovery time and fewer risks than open myomectomy.

A laparoscopic myomectomy is performed through the abdomen by the surgeon or via robotic-assisted technology. The success of a laparoscopic myomectomy is directly tied to the surgeon’s experience and expertise as it is a technically challenging procedure. One of the biggest challenges is the skill required to properly suture the uterus following the surgery.

Is a Laparoscopic Myomectomy Considered Major Surgery?

If a procedure requires an overnight stay in the hospital or longer, or is performed under general anesthesia and involves altering or removing a part of the patient’s body, it is considered major surgery. A myomectomy is considered a major surgery even when performed laparoscopically.

Why Would a Laparoscopic Myomectomy Be Performed?

A laparoscopic myomectomy is performed to remove non-cancerous fibroid tumors that grow in the uterus and are causing undesirable symptoms. If the fibroids are small, sparse in number, and are not deeply embedded, a laparoscopic myomectomy can be performed to remove them and alleviate symptoms such as:

  • Abnormal uterine bleeding;
  • Chronic pelvic pain and pressure;
  • Bowel pressure or urinary frequency;
  • Discomfort or pain during intercourse;
  • Fertility issues;
  • Other symptoms.
Major symptoms of uterine fibroids
Major symptoms of uterine fibroids

Who Is a Candidate For a Laparoscopic Myomectomy?

A woman who is experiencing unpleasant symptoms due to smaller, easily accessible fibroids that are growing on her uterus such called subserosal fibroids would be a good candidate for a laparoscopic myomectomy. Most experts believe that fibroids no larger than 9-10 centimeters (about 4 inches) should be the criteria for determining eligibility for a laparoscopic myomectomy. A laparoscopic myomectomy may not be a feasible option to eliminate fibroids that are large, numerous, or deeply embedded.

What to Expect From Laparoscopic Myomectomy?

A laparoscopic myomectomy is traditionally performed under general anesthesia. During a laparoscopic myomectomy, carbon dioxide gas is used to help open up the abdominal cavity giving the surgeon better access to remove the fibroids.

A few small incisions are created in the pelvic area and it is customary for the main entry point to be located in the belly button. A thin lighted tube with a camera on one end – a laparoscope – is inserted into one of the incisions to help guide the surgeon, and other small instruments are placed through the other incisions to remove the fibroid(s). Sometimes, the fibroid has to be sectioned into smaller pieces before it can be removed.

After the fibroids are removed, the uterus is sutured back together using many layers of stitches. Laparoscopic myomectomy surgery can compromise the integrity of the uterus and require a C-section for delivery if pregnancy occurs after the procedure. Additionally, postoperative uterus scarring can decrease the chances of conceiving after the myomectomy.

What Is a Robotic Myomectomy?

A robotic myomectomy is a specific technique used to perform a laparoscopic myomectomy. A laparoscopic myomectomy can be done by a surgeon or with the use of robotics (robotic laparoscopy), where the surgeon is controlling robotic arms via a computer console. The surgeon is able to more easily access tiny spaces, has a better view of the surgery site, and can control the instruments more smoothly and precisely.

Recovery From Laparoscopic Myomectomy Surgery

After a laparoscopic myomectomy, some patients may be discharged to return home the same day and others stay in the hospital overnight or for a few days. Each patient is different and depending on how many fibroids were removed, the length of time in surgery, and other factors, the hospital stay will vary by patient. Upon discharge, the patient is normally given prescriptions for pain control, aftercare instructions, and activity restriction instructions.

Patients who have a laparoscopic myomectomy generally experience fewer complications than those who undergo an open myomectomy, and their recovery is a bit shorter. The typical recovery time after a laparoscopic myomectomy is 4 to 5 weeks.

During recovery patients can expect:

  • A small amount of vaginal bleeding or staining from a few days to six weeks after the procedure;
  • Pain in the shoulders or back caused by the gas used to open up the abdominal cavity to assist the surgeon during the procedure;
  • Mild to moderate uterine cramping and discomfort that can be alleviated through over-the-counter pain relievers;
  • Sleepiness and fatigue or other symptoms related to the use of general anesthesia.
  • The surgeon will let the patients know when they can resume their normal work and activity levels.

Risks and Side Effects of Laparoscopic Myomectomy:

Although there are fewer risks associated with laparoscopic myomectomy versus an open myomectomy, there are always risks involved in any surgical procedure. Some risks include:

  • Adverse reaction to general anesthesia;
  • Damage to nearby organs;
  • Excessive bleeding/blood transfusion;
  • Blood clots;
  • Infection;
  • Uterine puncture;
  • Inability to completely remove the fibroids;
  • Weakening of the uterus (may rupture during a vaginal birth);
  • Development of scar tissue inside the uterine cavity that could cause fertility issues.

Uterine Fibroid Embolization Vs. Laparoscopic Myomectomy

If you have been diagnosed with uterine fibroids, you may be a candidate for a non-invasive procedure that does not involve risks of damaging your uterus or other organs. Uterine Fibroid Embolization (UFE) is a non-surgical procedure that is 90% effective in eliminating all fibroid symptoms, regardless of the number and size of the fibroids. It shrinks all the fibroids by blocking the blood flow that is feeding them and making them grow. It is important to understand that the blood flow is blocked only to the fibroids, not to the uterus, so women keep the uterus and can get pregnant after UFE.

Unlike a laparoscopic myomectomy, UFE addresses and eliminates all types of uterine fibroid. UFE has a recovery time of about a week allowing a woman to quickly return to normal life. There are no stitches or general anesthesia involved, the patients leave the clinic with only a bandaid, usually the same day.

Contact Atlanta Fibroid Center® at (770) 953-2600 or make an appointment online to see if you are a candidate for UFE.