Laparoscopic myomectomy

Laparoscopic myomectomy

Laparoscopic  myomectomy is a fertility-sparing procedure to remove fibroids, which  are non-cancerous tumors that affect up to 80 percent of women by age 50. The uterus is left intact after the procedure.   Removing them laparoscopically lets the patient recover faster after the procedure.  She will have just 2 or 3 small incisions on her abdomen and she can get back to work faster.

Once a patient is through recovery from a myomectomy, menstrual cycles should normalize, and there should be a noticeable difference in the level of pain. After at least 3 months, women can pursue fertility options. It is essential for the uterus to be completely healed before trying to conceive.

If hysterectomy for fibroids is indicated, it is important to get a second opinion. Age and fertility are the most important factors for these procedures. For some patients, laparoscopic myomectomy may still be an option. The author has removed fibroids as large as 10 cm laparoscopically and the patients have delivered at term after laparoscopic myomectomy.  Even 6-7 fibroids have been removed laparoscopically by Dr.Shobhana Mohandas on request by the patient.  It is not recommended for women who are past fertility to undergo a myomectomy, as it is a more invasive procedure than a hysterectomy. However, some patients demand that hysterectomy should not be done for them and in those cases, and in younger patients, even after completing their family, laparoscopic myomectomy is a choice.

 

Dr.Shobhana Mohandas has been practicing laparoscopic surgery for more than 2000 patients at a high level of expertise and several patients have undergone this procedure under her care.

Advantages of laparoscopic procedure;

Laparoscopic myomectomy offers many advantages compared to open abdominal surgery such as:

  • Enhanced recovery
  • Short hospital stay
  • Cosmetically improved scar
  • Reduced adhesions (scarring) from the procedure
  • Comparable pregnancy rates

Length of procedure;

For average size fibroids, myomectomy by Dr.Shobhana takes just over an hour.  Large fibroids and multiple fibroids may take longer.

 

The less time under anesthesia is better for the patient, but it is important to also perform a thorough procedure.

Hospital stay:

Generally the procedure is done in the afternoon and the patient goes home next day itself.  In case there are accompanying pathologies like adhesions due to endometriosis, convalescence may be longer.

How long is the Laparoscopic myomectomy recovery?

Fibroid removal with Laparoscopy performed using just 3-4 small incisions, so the pain from surgery is significantly less Most women are back to their normal activities within 10-14 days. 

Pregnancy or childbirth complications. A myomectomy can increase certain risks during delivery if you become pregnant. If there are  deep incisions in your uterine wall, there may be need for cesarean section in a subsequent pregnancy to avoid rupture of uterus during labour, a very rare complication of pregnancy.  Under Dr.Shobhana’s care, post myomectomy patients have undergone normal delivery or cesarian section depending on site and size of the tumour.

After effects: 

After surgery to remove one or more fibroids, you may feel some pain in your belly for several days. Your belly may also be swollen. You may have a change in your bowel movements for a few days. And you may have some cramping for the first week. You will feel tired, but will be able to eat and drink normally, walk around and go to the toilet.

Shoulder or back pain usually caused by the gas after laparoscopy in other centres is almost not seen under care of Dr.Shobhana as the gas is sucked before closing the abdomen.To help with pain,  medicines will be prescribed.. You will need 2 or more weeks to fully recover.

You may have light bleeding for up to 8 weeks. You may have a brown or reddish brown vaginal discharge or spotting for a few weeks or until your first period. This is normal. Expect your first two periods to start early or late. They may be more painful or heavy than usual.

How are adhesions prevented?

With laparoscopic approach, there is minimal tissue handling which reduces risk of adhesions. Saline irrigation is also constantly in use which prevents drying of tissues and blood clots from sticking to the tissues. Meticulous control of bleeding also is essential.

 


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