What are Uterine Fibroids?
Women with large fibroids, or an enlarged uterus often undergo robotic or open procedures at the recommendation of their general practitioner or OB/GYN because they don’t have extensive laparoscopic training. When a doctor tells you that you aren’t a candidate for minimally invasive surgery, it could very well be that it’s not you, but the doctor who isn’t the right fit for the surgery you require.
Large Fibroid Procedures: Myomectomy Or Hysterectomy
There are two surgical treatment options for fibroids:
• Myomectomy — removal of fibroids only
• Hysterectomy — removal of uterus and fibroids
If you are planning to have children and/or are willing to undergo additional surgeries in the future if the fibroids return, a myomectomy preserves the uterus while removing the fibroids.
The main reason a myomectomy is performed is to preserve the uterus for pregnancy, or to remove fibroids that are preventing the uterus from becoming pregnant. However, removal of fibroids and keeping the uterus will not prevent fibroids from recurring. If fibroids return to the uterus, it could require either another myomectomy or a hysterectomy.
A hysterectomy removes the uterus and the cervix, as well as the fibroids. This is the most definitive treatment for removing fibroids. While the thought of this can be overwhelming, it’s important for women to understand that the ovaries are responsible for making hormones, not the uterus. Removing the uterus will stop menstruation, but it will not begin menopause. If childbearing is not a consideration, a hysterectomy can be the most effective treatment.
Fibroids are usually diagnosed during a gynecologic examination. The presence of fibroids is most often confirmed by a lower abdomen ultrasound. Fibroids can also be confirmed using MRI (magnetic resonance imaging). These imaging techniques serve as a baseline examination for follow-up after uterine fibroid embolization (UFE).
What Problems do Fibroids Cause?
- No Symptoms : most fibroids up to the size of an orange (12 weeks pregnancy) cause any symptoms. Their mere presence is not a reason to treat them.
- Submucus : They protrude into the uterine cavity and cause menstrual cramps, heavy periods, infertility and repeated miscarriages. The diagnosis is often missed as the uterus is not enlarged and unnecessary hysterectomies have been performed for these. The diagnosis is made by hysterosonography or hysteroscopy.
- Intramural : These fibroids are within the muscle of the uterus and can be very large. Because they enlarge the cavity of the uterus they can also cause heavy periods. The most common problem is PRESSURE symptoms on the bladder and rectum.
- Subserous : These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. TORSION (twisting) is a very rare complication.
- Degeneration : Rarely there is liquifaction and bleeding within the center causing pain and fever. Infection may also occur. The most common occurrence is during pregnancy. Treatment is never surgery but conservative with fluids, pain and antibiotics.
Fibroids and Infertility, Miscarriage
1.Usually, the submucus fibroids cause repeated miscarriages.
2.Large intramural fibroids may be the cause of longstanding infertility if all other causes have been excluded.
Laparoscopic (Minimally Invasive) Fibroids Treatment – Uterine Fibroids Surgery at World Class Hospitals in India
Surgical Treatment :
1) The treatment for removing the fibroids from the uterine muscle is known as MYOMECTOMY.
2) It is a specialized operation where the uterus is preserved for future fertility and only fibroids are removed.
3) This operation is traditionally done through a LAPAROTOMY via a ‘bikini’ or ‘up and down’ incision.
4) When the fibroids are less than 5 and less than 18 weeks size LAPAROSCOPIC myomectomy can be performed.
Laparoscopic Myomectomy (Keyhole, Minimally Invasive procedure to remove fibroids)
Myomectomy is the most suitable surgery option for women who have fibroids but wish to retain their uterus.
Laparoscopic Myomectomy :
The advantage of this is that patients can go home the same or next day and be back to work in 1-2 weeks.
We use laser, harmonic scalpel, knife or electro surgery to remove the fibroids. The skill of the surgeon is paramount to results.
Minilap Myomectomy :
This is another technique pioneered at our center where large multiple (up to 24 weeks) can be removed through a 2-inch bikini incision.
Patients can go home the next day after surgery.
Hysteroscopic Myomectomy :
Submucus fibroids are removed by inserting a hysteroscope (small camera passed through the Vagina) and an electrical loop is used to remove the protruding part. This is rapid and effective surgery without the need of laparoscopy.
Estrogen is used after surgery to promote uterine lining re growth.
Total Laparoscopic Hysterectomy :
When the family is complete and patient has a symptomatic fibroid, the whole Uterus is removed via only four small holes in the tummy using laparoscopic technique.
Laparoscopic Myomectomy has many advantages over the abdominal (open) approach :-
You can get several benefits which has helped a large number of patients from all around the world to get high quality medical treatment in India at best value.
- Minimal Pain.
- Minimal Blood Loss.
- Early Post Operative Recovery.
- No Scar.
- Faster Recovery.
- A shorter hospital stay.
- Decreased Adhesion formation.
- Better chances of post surgery pregnancy.