What Is Myomectomy?
Myomectomy refers to the surgical procedure for the removal of fibroids (extra fibrous tissue growth) from the uterus. It is a preferred treatment for females with symptomatic (presence of symptoms) fibroids who want to avoid hysterectomy (surgical removal of the uterus) procedures. This article further discusses the surgical technique, clinical outcomes, associated complications, advantages, and advances of laparoscopic myomectomy procedures.
What Is Laparoscopic Myomectomy?
Laparoscopic (a thin tube with an attached camera is used to improve the visibility of internal organs) myomectomy is a preferred surgical option for treating symptomatic uterine fibroids. This procedure is minimally invasive, which means it causes less discomfort and has a shorter recovery time than traditional open surgery.
The surgical procedure is usually performed for cases with a fibroid size of more than four inches and a fibroid of less than two inches. The duration of surgery is around three to four hours, depending on the case. Usually, three to four surgical incisions (surgical cuts) are placed in the abdomen based on the uterus size. One incision of 12 millimeters is made at the umbilicus (navel), and the rest are smaller (5mm). Fibroids are dissected and excised from the uterus using specialized laparoscopic instruments. Hemostasis (control of bleeding) is achieved meticulously to minimize blood loss. Closure of the uterine defect may involve suturing techniques or tissue-sealing devices. Preoperative evaluation includes imaging studies such as ultrasound to assess fibroid size, location, and number. Adequate counseling regarding the procedure, risks, and expected outcomes is essential before initiating the procedure.
What Are the Advantages of Laparoscopic Myomectomy?
The laparoscopic myomectomy procedure offers the following benefits:
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Quick recovery time.
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Shorter hospital time.
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Minimal scarring.
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Minimized adhesion formation following the procedure.
What Are the Advances in Laparoscopic Myomectomy Techniques?
Various advances in laparoscopic myomectomy techniques are:
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Morcellation Techniques: Advancements in morcellation (a surgical procedure to remove the uterus or other growths) techniques have led to the development of devices that can remove larger fibroids through smaller incisions, reducing operative time and improving cosmetic results.
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Used of Barbed Sutures: Barbed (knotless surgical sutures with barbs on them) sutures have become a popular choice for suturing myometrial defects due to their improved efficiency and ease of use.
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DualPortGYN System: The DualPortGYN system is an innovative approach that enables single-incision laparoscopic myomectomy, reducing incisional morbidity and enhancing cosmetic outcomes.
Clinical Outcomes
Laparoscopic myomectomy is a surgical procedure that is associated with several benefits compared to open surgery. Firstly, it leads to significantly reduced blood loss, which minimizes the need for blood transfusions and reduces the risk of postoperative complications. Secondly, it enables the preservation of fertility by sparing the uterus and minimizing the formation of adhesions during surgery. Thirdly, patients who undergo laparoscopic myomectomy experience less postoperative (after surgery) pain, shorter hospital stays, and quicker return to daily activities compared to those who undergo open surgery.
Future Pregnancy and Risk of Uterine Rupture:
One of the primary concerns for women undergoing laparoscopic myomectomy is the impact on future pregnancies and the risk of uterine rupture during childbirth. While the procedure itself is generally safe, the presence of uterine scars resulting from fibroid removal may increase the risk of uterine rupture during labor.
Several factors influence the risk of uterine rupture, including the location and size of the fibroids removed, the extent of uterine wall involvement, and the number of fibroids treated. Additionally, the surgical technique used during myomectomy can affect the integrity of the uterine wall and subsequent pregnancy outcomes.
Studies have shown that the risk of uterine rupture after laparoscopic myomectomy is low, particularly when compared to the risk associated with prior cesarean sections. However, it is essential for patients to discuss their individual risk factors with their healthcare provider, as certain factors, such as the presence of large or multiple fibroids, may increase the risk of complications during pregnancy and childbirth.
Post-Surgical Care
After surgery, patients should be given strategies for managing pain, encouraged to start walking as soon as possible and have a follow-up schedule to monitor recovery and assess for complications. Additionally, they should receive counseling on both family planning and fertility preservation options.
What Are the Complications Associated with Laparoscopic Myomectomy?
However, it is important to note that while laparoscopic myomectomy is generally safe, there are potential complications, such as:
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Intraoperative bleeding (bleeding during the surgery).
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Injury to adjacent organs and other surrounding vital structures may occur in a few cases.
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Postoperative adhesion formation.
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Surgical site infection after the surgical procedure.
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Recurrence of uterine fibroid growth (there are chances of recurrence of growth in a few cases).
Future Perspective: There are several promising advancements that can improve the outcomes of fibroid treatment. These include:
1. Robotic-Assisted Myomectomy: Robotic platforms can improve surgical outcomes and make minimally invasive myomectomy more feasible by offering enhanced dexterity and precision.
2. Focused Ultrasound Surgery (FUS): FUS is a non-invasive alternative for fibroid treatment that uses targeted ultrasound energy to ablate fibroids while preserving surrounding tissue.
3. Enhanced Imaging Modalities: Advances in imaging techniques such as MRI-guided (magnetic resonance imaging) focused ultrasound and contrast-enhanced ultrasound may improve preoperative planning and intraoperative visualization, leading to better surgical outcomes.
Conclusion
Laparoscopic myomectomy is a surgical procedure that has seen improvements in recent years due to advancements in surgical techniques, instrumentation, and adjunctive therapies. The procedure has numerous benefits such as reduced morbidity, preservation of fertility, and improved patient satisfaction, making it an important part of the management of symptomatic uterine fibroids. As technology continues to advance, further refinements in surgical approach and adjunctive therapies show potential for optimizing outcomes and expanding the applicability of minimally invasive treatment options for women with uterine fibroids.
