Fibroids removal by Laparoscopy treatment if present in uterus | Blog By Dr. Monica Agarwal, Paras Bliss, Panchkula, Mohali and Chandigarh
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Can I Have my Fibroids Removed Laparoscopically If They are Located Inside The Uterus?

Can I Have my Fibroids Removed Laparoscopically If They are Located Inside The Uterus?

by: Dr. Monica Agarwal
Consultant Obstetrics & Gynecology - Paras Bliss, Panchkula

Fibroids are very common benign tumours of the uterus. 70-80% of females of reproductive age group have uterine fibroids. These can be discovered by chance or due to the symptoms that they may cause – depending on the size, number and location. Fibroids near the cavity usually cause abnormal uterine bleeding and pain. Fibroids away from the cavity and subserosal can be asymptotic. Less than 1% are malignant. If they are asymptotic and small then there is no need of treatment, only observation is indicated. Treatment for fibroids can be medical or surgical. Surgical therapy includes myomectomy or hysterectomy (abdominal or vaginal).

Surgical Treatment of Fibroids:

Myomectomy involves removal of just the fibroid and preservation of uterus. This procedure retains the fertility and menstrual function of the women. Open abdominal myomectomy is a complicated procedure because of many reasons and hence these days laparoscopic myomectomy is the preferred choice. In this technique, fibroids are removed from the uterus by a laparoscope. It involves delicate techniques like laparoscopic suturing and tissue removal and should be done with a competent surgeon capable of handling all this. Prior to that endometrial biopsy and diagnostic hysteroscopy should be done to rule out premalignant and malignant conditions.

Advantages of Laparoscopy Surgery for Fibroid Treatment:

  • Faster recovery
  • Short hospital stay
  • Small scar
  • Reduced adhesions
  • Increased pregnancy rates

Myomectomy can be performed as a hysteroscopic, open and laparoscopic procedure.

Hysteroscopy- Submucous fibroids less than 4 cms in size can be resected by a transcervical approach. Hysteroscope is inserted through the mouth of the uterus and fibroid is removed.

Laparoscopic- This is done when the largest fibroid is less than 10 cm in size and a total number of fibroids is less than 5.

Preoperatively full history, clinical examination, USG and if required MRI is also done.

Laparoscopy Surgery Procedure for Fibroid Treatment:

  • Done under general anesthesia
  • 3-4 small ports are made in the abdomen. One is large about 10 mm and others are small 5 mm.
  • Fibroids have a lot of blood supply, so they are prone to bleed during removal. So this needs a lot of planning and precision to prevent a hysterectomy.
  • Large fibroids are cut into small pieces by a morcellator and extracted out of the small incision.
  • To prevent adhesions, minimal tissue handling is done and saline irrigation is done constantly to prevent drying of tissues and blood clots sticking to the tissues.
  • Control of bleeding is done and other adhesion prevention measures are used
  • Pregnancy can be planned after this and the operating surgeon can advise whether LSCS is indicated or a trial of vaginal delivery can be done
  • Discharge is usually after 48 hours. Pain is controlled by analgesics
  • You can do light activities like short walk, shower etc
  • Plenty of rest is needed
  • Sutures are removed after 7-10 days
  • Return to normal activities takes around 4-6 weeks.
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