Laparoscopic Myomectomy
Laparoscopic
myomectomy (often spelled as laproscopic) makes
sense for subserous and pedunculated myoma. Subserous
are close to the outer surface of the uterus, while pedunculated
myoma are myoma "hanging" on a stalk to the uterus. Laparoscop
is usually inserted through the navel and from there the operation
proceeds. Laparoscopy requires several small incisions, so recovery
time is much shorthened as compared to conventional or abdominal
myomectomy.
You
can see laparoscopic
myomectomy videos here.
Just
as with any other type of myomectomy, the goal of laparoscopy
is to stop heavy bleeding and pressure on the internal organs
from the (possibly large) fibroids. Theoretically, it is possible
to get rid of any kind of uterine fibroids with laparoscopic
myomectomy, but the fact is it works best if there were one
or two large fibroids. With other types of myoma present, laparoscopy
may not be ideal solution, since there will be a defect in the
uterus on the place occupied by the fibroid that was taken out,
and that defect must be repaired in order to prevent complications.
Whom Laparoscopic Myomectomy Is For?
To be eligible for this surgical procedure,
the following conditions should be met:
(1)
No individual myoma should be larger than 7 cm.
(2)
If there are multiple myomata, the uterine size should not be greater
than 14 weeks.
(3)
No myoma should be near the uterine vessels or tubal cornua. At
least 50% of the myoma should be subserosal. Hysteroscopic
myomectomy (a.k.a. operative hysteroscopy) is the preferred
procedure for removal of submucous myomas.
Laparoscopic Myomectomy with Colpotomy
If there are large fibroids in the uterus,
a colpotomy
-- another incision in the vagina -- is needed. This procedure cannot
repair the defects left by the fibroids, and must be performed in
conjunction with another kind of surgery.
Laparoscopic Assisted Myomectomy
Laparoscopic Assisted Myomectomy (LAM) is
a laparoscopic procedure which also includes a small traditional abdominal
incision (minilaparotomy) to remove the fibroids. This type of procedure
can be used for any size of fibroid. Because the incision is only
4-5 cm, recovery is quicker than from a conventional myomectomy.
Laparoscopic-Assisted Transvaginal Myomectomy
This is a combination of traditional laparoscopic
myomectomy and posterior colpotomy, which enables the surgeon to inspect
and repair the uterus digitally, while still operating within the
benefits of minimally invasive surgery.
Laparoscopic-Assisted Vaginal Myomectomy
Conditions for success with LAVM are:
(1)
Removal of the dominant myoma must render the uterus mobile enough
to be delivered to the colpotomy site; and
(2)
The vagina and cul-de-sac must be ample enough to allow for generous
colpotomy (parous preferred).
Colpotomy,
rather than minilaparotomy, lends itself better to removal of large
transmural myomas, and the surgeon may inspect the myoma cavity
and repair the uterine defect better. Within this technique blood
loss can be as small as it gets.
Problems with Laparoscopic Myomectomy
t can be a lengthy and difficult procedure,
reserved for experienced surgeons with a thorough familiarity with
endoscopic sutures. Always talk to the surgeon and assess how experienced
he or she is in laparoscopic myomectomy.
In
some cases, it results in excessive blood loss, prolonged operating
time and/or the need to convert to laparotomy. And by the way, the
surgeon may decide upon complete hysterectomy, depending on the
state of the entire body.
Laparoscopic
suturing of the myometrium may contribute to uterine dehiscence,
which goes contrary to the very reason of undertaking myomectomy.
Its main practical goal is that the patient can achieve successful
pregnancy, and uterine dehiscence means that there may be
a weak spot in the uterus, which might cause the uterus to rupture
in pregnancy.
For
laparoscopic myomectomy better suturing tools are needed. Ask the
hospital whether they have them and whether they use them.
Advantages of Laparoscopic Myomectomy
The main advantage is shorter hospital stay,
say 3 hospital days versus myomectomy by laparotomy with its 5 or
more hospital days after surgery.
However,
as minimally invasive as it gets, laparoscopic myomectomy still
is a real surgery and may need every bit of patience to recover.
It would be a grave mistake to just read about how other women got
well in two weeks and surmise that that will be the case with you
too...
Some
other types of myomectomy may be of interest to you as well.
If
childbearing is not important in your particular situation, endometrial ablation may also be an viable surgical
alternative to hysterectomy. For a list of energy healing methods
that can directly destroy myoma of uterus, without any surgery at
all, please visit our Fibroid
Treatments page.
Return from Laparoscopic
Myomectomy to How To Avoid Hysterectomy home page.
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