Laparoscopic myomectomy is removal of Fibroids from the uterus laparoscopically.
Removal of fibroids was traditionally done either by making large vertical or horizontal cut over the abdomen.
The decision to perform surgery for uterine Fibroids is complex and varies from patient to patient based on their medical co-morbidities, surgical history, clinical scenario and patient preference.
In general, consideration for a myomectomy is given in patient with symptomatic fibroids who wants to conserve uterus.
• Excessive uterine bleeding refractory to medical management resulting in anemia.
• Pelvic discomfort/pain caused by myomata. Acute and severe or chronic lower abdominal pain or low back or pelvic pressure.
• Fibroids those are palpable abdominally.
• Fibroids causing infertility.
We use modern equipments like Cord less ultrasound dissector- Sonicision, Hormonic and modern electro surgery unit to perform this operation. Largest fibroid removed in our operation theatre was as large as 700gms in weight. Maximum number of fibroids removed is 21 in single surgery.
During Laparoscopic myomectomy main incision is taken at or near the umbilicus-navel from which laparoscope goes inside. Carbon di-Oxide gas goes inside the abdominal cavity to distend/ bloat the cavity. We call it as a pneumoperitoneum. Once pneumoperitoneum is created, three or four more incisions are made on either of the sides.
Various instruments go inside the abdominal cavity and surgery is performed.
During removal of fibroids, intra operative blood loss is one of the main concerns. This blood loss is prevented by injecting diluted vasopressin injection in the uterus at the site of fibroid. A cut is taken on the uterus over the fibroid and fibroid is taken out by maneuvering it by instruments like myoma spiral, different holding instruments (Forceps).
Once entire fibroid is taken out of uterus, we close the defect left behind in one or two layers (depending upon the depth of the defect. Now a day’s special barbed sutures are available which makes suturing very fast and secure.
After suturing is done, we confirm that there is no bleeding from the wound on the uterus. Next important step is to remove fibroid out of the abdominal cavity. Fibroids are of various sizes and they have to be removed from small incision of around 1 to 1.5 cm in diameter. This is done by the process of morcellation.
Morcellation is the process in which rotating cutting blade goes inside the abdominal cavity, which cuts fibroid tissue in to small 1 to 1.5 cm diameter pieces just looking like finger chips. More advances are taking place in the morcellation procedure. En bag morcellation is preferred now as it is done completely inside a medical grade plastic bag. Complications like injury to other organs are lesser with in bag morcellation, so also chances of spread of undiagnosed malignancy is also not there.
Laparoscopic myomectomy is safe, less painful. Patient recovery is very fast as compared to traditional myomectomy. Patient can be discharged practically on very next day of the surgery. Laparoscopic myomectomy may have some complications, such as injury to urinary bladder, intestines or ureter or major blood vessels. Rate of such complications is as low as 1 % but such complications can also occur in traditional open surgeries.