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.