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Laparoscopic myomectomy

What is a myoma?

Hysteroscopic myomectomy - Myoma uteri
Myoma uteri

A myoma (also known as fibroids) is a cellular proliferation on the uterus, formed by connective tissues and smooth muscle cells. A benign tumor, which is associated with hormonal changes, related to the estrogen level in the body. Higher estrogen level potentiates the growth of the fibroids, and in case of decrease of the hormone level, the size of the nodes would decrease too.

The size of the fibroid could be about a few millimeters to a size of a human fist. However, the size of myoma is not always commensurate with the symptoms caused.

Based on the location, fibroids can be divided into 3 groups, which, for this reason, cause different complaints and can be cured by different procedures. The following table is presenting the properties of each myoma type:

  Intramural myoma Subserous myoma Submucosal myoma
Location uterine wall surface of the uterine endometrium
Complaints caused abnormal menstrual bleeding, longer, painful menses, lower chance of conceiving may exert pressure on the surrounding organs (rectum, bladder, hipbone), causing urinary and bowel disorders and pelvic pain it can distort the uterine cavity, reduce the chance of becoming pregnant, increase the chance of infertility and abortion
Curing method Laparoscopic myomectomy Laparoscopic myomectomy Hysteroscopic myomectomy

When is the procedure indicated?

In some cases, the fibroid doesn’t cause any complaints, but also in this case a semi-annual check is recommended to avoid serious symptoms in the future.

If the size or the location of the myoma causes serious complaints or its size is growing too fast, the removal of the fibroid is recommended. Nowadays medical practice prefers organ-retaining surgeries instead of hysterectomy, to avoid unpleasant after-effects of the uterus removal.

In the case of organ retention surgeries, the minimally invasive, laparoscopic (abdominal) or hysteroscopic (uterus) procedures are performed instead of risky, long recovery open abdominal surgery. Fibroids located in the endometrium are removed with a hysteroscopic procedure, if the myoma is located in the uterine wall or on the surface of the uterine, laparoscopic myomectomy is performed.

How does laparoscopic myomectomy go?

If the removal of the myoma is recommended, at first the doctor creates an accurate “map” of the uterine with the location of the fibroid(s). This ultrasound diagnosis will help the detection of the cell growths during the procedure.

The advantage of the laparoscopic procedure is that the traditional, large incision opening of the abdominal wall is avoidable, so the possibility of concrescence is much lower and the postoperative recovery is faster.

The surgery is prepared in anesthesia. Before the operation, the abdominal cavity is filled with carbon dioxide gas, which helps the exploration. On 4 places, 5-10 mm incisions are made on the abdominal wall, where the microsurgical and optical devices are inserted. During the myomectomy, first the uterine wall is opened above the myoma, then the surgeon uncover the fibroid which are dismembered and removed from the abdominal cavity with a special equipment. Finally, he closes the lesion of the uterine wall through the small opening and closes the incisions too. The duration of the operation depends on the size, number, and position of the fibroids.

What are the risks of the operation?

The recommended hospital stay after surgery is 2-3 days, which could be extended by the specialist, depending on the healing. The removal of the stitches is performed 1 week after the operation. The average length of postoperative recovery is 2-4 weeks, while a health conscious, easy lifestyle is recommended.

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