Laparoscopic Myomectomy

A uterine fibroid, also known as leiomyomas or myomas, is a benign (noncancerous)growth of the uterus, either in or around the uterus. Generally, it occurs most commonly in women aged between thirty and forty (child Bearing age). In most conditions, fibroid does not need any surgery. Uterine fibroids are non-cancerous. They are not associated with an increased risk of uterine cancer and almost never develop into cancer.

But in severe conditions, effective treatments are available. Non-surgical methods can decrease pain and bleeding. But sometimes, surgery is necessary to remove the fibroid from the uterus. Laparoscopic fibroid removal surgery is a type of minimally invasive surgery technique. In this method, the fibroid from the uterus is removed by making a small keyhole. Advanced instruments like laparoscopes are used in this technique.

1. Laparoscopic myomectomy offers several benefits to patients such as less blood loss during operation, quick postoperative recovery
2. Shorter hospital stays in comparison to an open myomectomy.
3. It has been widely used over the past decades as a possible alternative to traditional laparotomy.

Why is this procedure done?

The procedure of laparoscopic fibroid removal may be performed to treat and solve the following symptoms of uterine fibroid:

1. Bleeding when you are not on periods
2. Pain during sex
3. Pain in the lower back
4. Constipation
5. If you are not able to urinate or unable to empty the bladder
6. Heavy menstrual bleeding.
7. Pain in legs.
8. Laparoscopic fibroid removal includes laparoscopic or robotic myomectomy and laparoscopic or robotic hysterectomy.

The procedure of laparoscopic fibroid removal 

This process takes around two to four hours. However, the time may increase if the number of fibroids is more.

1. The patient is placed in the lithotomy position.
2. A uterine manipulator (A device used to hold the muscles for better viewing) is inserted inside the uterus for controlling the position of the uterus.
3. A small cut is made above the naval. Then, three more cuts are made on the abdominal region of the patient. These cuts are made such that it forms a triangular confirmation.
4. Then the surgeon inserts a laparoscope (a thin and flexible tube with a camera and light at its head) into the abdominal cavity.
5. Other instruments like forceps are inserted through other pores.
6. A suturing thread is then passed through each fibroid, and after that, all the fibroids are cut.
7. After passing the thread through all the fibroids, the uterine manipulator is removed from its place.
8. Then the surgeon cuts the fibroids present in the uterus. 
9. Then an exit portal is created in the vaginal area.
10. Then, all the fibroids are withdrawn through the vaginal exit.
11. After this, all the cuts are sutured using a dissolvable thread.

What to expect before laparoscopic fibroid removal

Before starting the surgery, the surgeon may advise you to undergo laboratory tests. It is done to know the stage of fibroid in a better way. They may order tests like: 

1. Ultrasonography: This is a non-invasive test. It creates an image of internal organs.
2. CT scan: It uses x-rays to provide an image of the internal organs.
3. MRI scan: It uses magnetic beams and radio waves to deliver a high-quality image of internal organs. 
4. Laparoscopy: This uses a thin tube with a camera and a light at its tip to view the fibroids present.
5. The doctor may ask you to stop drinking and eating from midnight before the day of surgery.
6. The doctor may ask you to stop taking some medicines, like aspirin, ibuprofen and blood thinners, that increase risk of bleeding.
7. What to expect on the day of laparoscopic fibroid removal. 12, 13
8. When you reach the hospital, a staff member will help you to perform formalities, such as filling the informed consent form. It helps in confirming the information of the patient.
9. Always wear comfortable and loose cloth when going for surgery.
10. Leave contact lenses, cosmetics, and jewellery at home.
11. A nurse will guide you to the pre-operative area. There you will be asked to change into a gown.
12. They will then check the vital signs like blood pressure and pulse rate of the patient.
13. The staff will cross-check the information about the patient, like date of birth, father's name, and name of the procedure.
14. Then they will place an intravenous line on the arm, and the patient will be wheeled into the surgery room.

What to expect during surgery?

1. The procedure of laparoscopic fibroid removal is done under the influence of general anaesthesia. That is why you will not feel any kind of pain or sensations.
2. An intravenous line will be inserted into your arm. It is used to deliver the medicines if required in between the surgery.
3. A thin tube will be inserted into the mouth after giving anaesthesia. It is done for easing breathing during operation.
4. The size of cuts made is about 1 centimetre or less.
5. All the vital signs like blood pressure, pulse rate and heart rate are continuously monitored during the surgery.

What to expect after surgery? 

1. During discharge from the hospital, the doctor will prescribe some medicines to reduce the pain after the operation.
2. The doctor may give you some advice regarding care at home. He will also discuss with you the restrictions in diet and activities.
3. You may experience staining and vaginal spotting up to six weeks after the surgery.

First follow-up appointment

1. You may expect the following regarding your first follow-up visit:
2. The doctor will provide you with the date of the follow-up visit. Do not miss the follow-up visit.
3. During the follow-up consultation, the doctor will examine your overall health. 
4. The doctor will evaluate the incision possible for inflammation or pus formation.
5. You may also ask questions if you have any concerns or you are experiencing symptoms.
6. The usual follow-up visit would be within 4-6 weeks after the surgery.

When to Consult a Doctor?

1. Consult the doctor immediately if you are experiencing any of the following symptoms after the completion of surgery.
2. Bleeding.
3. Infection in the wound.
4. Difficulty urination
5. Irregular bowel movement
6. Damage to your internal organs like abdomen or bowel (often indicated by persistent high fever). 
7. No improvement in symptoms.