Dr Sarthak Sidapara

Laparoscopic Myomectomy

What is Laparoscopic Myomectomy?

Laparoscopic Myomectomy is a surgical procedure that involves the removal of fibroids without causing any damage to the uterus. It is also known as the Robotic Myomectomy in the medical word. When the fibroid starts to cause too much problem in daily life, the doctors may recommend this surgery. The symptoms which might lead to the surgery are Pelvic pain, Frequent urination, Irregular bleeding, Heavy periods. Laparoscopic Myomectomy helps to remove fibroids with small abdominal incisions. There are several forms of myomectomy techniques depending upon the location and size of the fibroids.

How do you prepare for surgery?

Mentally prepare yourself for a change. The surgery will definitely bring some changes to your body. Talk to your close ones or take help from professionals.

Follow these below-mentioned guidelines before your surgery:-

  • Avoid wearing jewelry
  • Try to wear loose-fitting clothes.
  • Doctors will restrict you to eat, drink ( not even water ), or smoke after midnight before the day of the surgery.
  • You must not wear nail polish before the surgery.
  • Wear low-heeled shoes before the day of surgery, as you might feel drowsy because of anesthesia.

What happens during the procedure?

There are various steps a surgeon follows during the laparoscopic myomectomy procedure. Your surgeon will make four small incisions of ½ inch long in your lower abdomen while you are under general anesthesia. The surgeon will be able to see inside your abdomen. It happens when your belly is full of carbon dioxide.

A laparoscope, i.e., a thin tube of light, along with a camera on one end, will be placed in one of the incisions. From the other incisions, small instruments will be placed. In the case of robotic surgery, your surgeon will use a robotic arm to control the instruments.

If your fibroids are small in size your surgeon may prefer to cut those fibroids into small pieces, and in case they are too large, a larger incision will be made in your abdomen to conduct an abdominal myomectomy. At the end of the surgery, all the instruments will be removed, the carbon dioxide gas will be released, and the incisions will be closed.

Types of myomectomy techniques

There are several forms of myomectomy techniques depending upon the location and size of the fibroids. Myomectomy procedures are done under anesthesia and in the operating room.

  • Hysteroscopic myomectomy

In the case of hysteroscopic myomectomy, surgeons use a narrow telescope to visualize the uterine cavity. The telescope is inserted into the vagina and then passed through the cervix enabling the surgeons to see the uterine cavity. This technique is used to remove small fibroids.

  • Laparoscopically-assisted myomectomy

This technique is used to remove the fibroids that extend into the uterine wall or the ones that are exposed outside the uterine cavity. A laparoscope is inserted into the abdomen along with other instruments.

  • Robotic-assisted laparoscopic myomectomy

This process is similar to laparoscopic myomectomy. The only additional point to know about this procedure is it uses robotics.

  • Open abdominal myomectomy

In this procedure, surgeons get direct access to the uterus through a vertical incision into the abdomen. The incision made in this procedure is the largest incision made as compared to other techniques. It also needs more time to heal. When fibroids are too large, surgeons prefer this procedure.

Symptoms that indicate the need for laparoscopic myomectomy

Below mentioned are the symptoms that might warrant a laparoscopic myomectomy. Before the actual surgery, the doctor will conduct several tests.

  • Constipation
  • Unusually heavy period
  • Pelvic pain
  • Difficulty while urinating
  • Frequent urination
  • Duration of Menstrual period longer than one week
  • Pain in legs and lower back

What are the complications and risk factors associated with laparoscopic myomectomy?

The procedure of laparoscopy is relatively safe, but it has certain risks too. These are –

  • Complications in pregnancy
  • Bleeding
  • Fertility issues
  • Organs in the abdomen are damaged
  • Urinary or bowel problems

There are two types of complications associated with laparoscopic myomectomy – intraoperative and postoperative.

Some of the intraoperative complications are:-

  • Enucleation
  • Hemostasis
  • Morcellation injury

Some of the post-operative complications are:-

  • Pelvic adhesion
  • Hematoma

Recovery tips for the patient

You may feel some pain and also have spotting after the surgery for a few weeks. For this, the doctor will prescribe some medications. Depending upon the kind of surgery performed, healing time can be estimated.

  • For hysteroscopic myomectomy, you will need two to three days of healing time.
  • In the case of abdominal myomectomy, the healing time is four to six weeks.
  • For laparoscopic myomectomy, the healing time will be two to four weeks.

You need to avoid exercising for too long and strenuously. Lifting of heavy goods and walking very fast must also be avoided. You must seek consultation before engaging in sexual activities. If you want to get pregnant, you must first have a detailed conversation with the healthcare professional.

What to expect?

Usually, you will need 6 – 8 weeks to recover after the surgery. You will feel extremely tired during this time. One needs to take rest as much as possible. You must also avoid lifting heavy goods.

After this surgery, you will no longer experience the menstrual cycle or be able to conceive. In any case, your ovaries are removed during the time of surgery. As a result, you will begin menopause immediately if you had not reached it. You might face some symptoms such as hot flashes, vaginal dryness, and night sweats.

Women also suffer due to fatigue after surgery. It may last for 10 weeks. But, sometimes, it can stretch until six months after the surgery.

Costs of laparoscopic myomectomy

One of the modern approaches to surgical treatment is laparoscopic myomectomy. Minimal invasive techniques are used in this surgery. The cost of this surgery varies a lot. It ranges from INR 3,50,000 to INR 5,50,000.