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Closed Myoma Surgery

If there are many causes and symptoms that make your normal activities difficult, such as excessive menstrual bleeding, pelvic pressure, or urinary incontinence, doctors may recommend a laparoscopic myomectomy. Some of the reasons for choosing myomectomy include:

  • If you plan to have a child
  • If fibroids interfere with fertility
  • If you want to preserve the uterus and remove only fibroids

Types of Myomectomy Techniques

Several techniques are used to remove the uterine fibroid. The choice of technique may depend on several factors, such as the location and size of the fibroids and the woman's characteristics. The various types of Myomectomy are:

Laparoscopic Myomectomy is performed to remove fibroids in the uterus. This technique is performed using a narrow telescope like an instrument to see inside the abdomen. The procedure involves 4 to 5 incisions in the navel and lower abdomen. Recovery time is about 2 to 3 weeks and requires a one or two night hospital stay. Complications such as bleeding, injury to internal organs, and infection may occur during this minimal procedure.

Abdominal Myomectomy, also called laparotomy, is performed using a vertical or horizontal incision in the abdominal wall. It allows the surgeon to reach the patient's uterus directly and uses traditional surgical techniques and instruments. Anesthesia is given to the patient and a full recovery is expected within 4-6 weeks.

Hysteroscopic Myomectomy involves the removal of a submucosal fibroid from the inner wall of the uterus. A narrow telescope-like instrument is passed through the cervix to visualize uterine activity to allow for surgery inside the uterus. This procedure is only done for smaller fibroids. This procedure is done under anesthesia in an operating room. Some of the complications encountered during this procedure are fluid overload, bleeding, wound formation in the uterus and uterine perforation.

How is Laparoscopic Myomectomy performed?

The procedure involves anesthesia, and then the surgeon makes four small incisions. Each of these cuts is about half an inch long in the lower abdomen. The navel is filled with carbon dioxide gas so that the surgeon can see inside the abdomen. A laparoscope is inserted into one of the incisions by the surgeon. A laparoscope is basically a lighted thin tube with a camera attached to one end. Small instruments are inserted into the other incision.

To remove the fibroids from the uterus, the surgeon cuts the fibroids into small pieces. If the fibroids are very large, abdominal myomectomy treatment is used, where large incisions are made in the abdomen to remove the fibroids. Fibroids are pushed out of the vagina or through small openings in the abdomen. After the fibroids are removed, the surgeon will remove the instruments, release the gas, and close the incisions.

Women usually have to stay in the hospital for about a day after the procedure is done. Doctors often prescribe oral pain medications after surgery and provide instruction on diet and activities. Women can expect spotting and vaginal spotting for just a few days to six weeks, depending on the type of procedure done.

Laparoscopic Myomectomy is a less invasive procedure in which women have less pain, lose less blood and return to normal activity more quickly than other treatments such as laparotomy.

Benefits of Laparoscopic Myomectomy treatment

Compared to other treatments, Laparoscopic Myomectomy is considered an effective, convenient and safe procedure to remove fibroids from the uterus. Some of the advantages are as follows.

  • It causes less blood loss during the operation.
  • The treatment does not take long after the patient is discharged in one day.
  • Provides rapid recovery after surgery

What are the risks of Laparoscopic Myomectomy?

Although Laparoscopic Myomectomy has low complications and associated risks, unique challenges can sometimes be encountered in some cases. Some of the risks involved in the procedure are:

Excessive blood loss, which is higher with larger uterus. Due to heavy menstrual bleeding, women already suffer from low blood counts (anemia). This poses a higher risk due to blood loss, and doctors always recommend ways to establish a blood count before surgery. An extra step is taken by doctors to prevent excessive bleeding, which involves injecting drugs around fibroids to constrict blood vessels and block blood flow to the uterine vessels. (Usually, the risk of bleeding increases in patients with more than 4 fibroids and more than 8 cm fibroids)

There may be a certain risk during pregnancy. Doctors may recommend cesarean delivery if there is a deep cut in the uterine wall. This is done to prevent rupture of the uterus during childbirth, which is a very rare complication of pregnancy. Fibroids are associated with complications in pregnancy.

If bleeding is uncontrollable and other abnormalities are found in addition to fibroids, there may be a rare chance of a hysterectomy where the surgeon removes the uterus. (Even with less than 1% probability, the uterus may not be preserved. However, this risk is significantly less with appropriate techniques and surgeries performed by experienced surgeons)

The chance of cancerous tumor spreading that may be mistaken as fibroids may be rare. If the tumor is removed through a small incision, it may cause the tumor to break into small pieces and spread. This chance and risk of such a condition may increase as women age and after menopause. In other words, the mass, which is thought to be a fibroid, can rarely turn out to be a malignant tumor. (The main and final result becomes clear and definite with the pathology result after the surgery!!!)

After surgery, adhesions may occur due to the incision made into the uterus to remove the fibroids. Mild menstrual periods and fertility difficulties may be experienced due to adhesions formed in the uterus.

After the myomectomy procedure, new fibroids have a chance to grow back. Young women are at greater risk than women close to menopause or with very few fibroids. The risk of recurrence from fibroids within 5 years after fibroid surgery is 40-60%. This rate varies according to the number of fibroids removed, size, location and age of the patient.

How can possible surgical complications be prevented?

Doctors recommend the following preventive measures to minimize the risk of myomectomy surgery

  • Heavy menstrual periods can cause iron deficiency anemia. Use of vitamin and iron supplements to increase blood count during surgery.
  • Myoma reduction therapy includes GnRH agonist therapy, which allows the surgeon to use a minimally invasive approach during surgery. This therapy can cause night sweats, hot flashes, vaginal dryness and menopause. These problems and discomforts do not occur after drug treatment.
  • Hormonal therapy is another way to prevent anemia and surgical complications. To reduce or stop menstrual flow, doctors recommend GnRH-releasing hormone agonists, birth control pills, and other hormonal drugs. These drugs inhibit the production of progesterone and estrogen, which stop menstruation, thereby allowing the body to produce hemoglobin and iron stores.

How to prepare before Laparoscopic Myomectomy?

A minimum of 8 hours of hunger and thirst is a must. In other words, it is necessary to stop drinking and eating liquids in the hours before the surgery. Before the operation, the doctor's instructions must be followed. If the patient is currently using any medication, it is preferable to consult a doctor to continue the medication.

General anesthesia is used for laparoscopic, robotic, abdominal and certain hysteroscopic myomectomy where the patient is asleep during the surgery.

Patients tips for post-surgery

Some of the suggested recovery tips for the patient after undergoing laparoscopic myomectomy treatment are as follows:

  • As it is likely to cause pain, doctors prescribe medication after surgery. It is recommended that the patient not lift anything heavy until the incision is completely healed. The first few days will be dressed. In addition, since gas is used in laparoscopy, mild shoulder pain and swelling are unpleasant conditions that you may feel on the first day. But it is not serious.
  • Doctors usually recommend waiting about 4-6 weeks after surgery before having sexual intercourse.
  • If you plan to become pregnant after surgery, the patient may need to wait about three to six months for the uterus to heal completely. It also depends on what type of surgery the patient has had.

We can talk and conclude that if an experienced surgeon performs laparoscopic myomectomy, it can be considered a safe technique with a good outcome in terms of pregnancy outcome and an extremely low failure rate.

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