Laparoscopic myomectomy refers to the removal of uterine fibroids using a laparoscope. A surgeon will make minimally invasive incisions (as opposed to an open abdominal incision) and guide a small camera through the incision. The feed is then streamed to a screen.
Uterine fibroids are noncancerous growths that form on the uterus. They can be asymptomatic or symptomatic. If symptomatic, they can cause vaginal bleeding, pelvic pain, lower back pain, pain during sexual intercourse, and constipation, and may interfere with fertility. In this case, surgery may be needed to relieve symptoms.
Who is a candidate?
Patients who suffer from smaller or fewer uterine fibroids that cause painful symptoms are good candidates for laparoscopic myomectomy. Patients who would like to retain fertility are also good candidates, as laparoscopic myomectomy allows for preservation of fertility in comparison to the traditional method of treating uterine fibroids (hysterectomy).
Who is not a candidate?
Patients with larger uterine fibroids may not benefit from laparoscopic myomectomy, and should consider a traditional myomectomy or hysterectomy for successful removal of fibroids and relief from symptoms.
A preoperative assessment discussing treatment, anesthesia, and hospital stay should be scheduled in order to prepare mentally for the procedure. Any blood thinners such as aspirin and other pain relievers should be discontinued 7 days before the procedure to reduce the risk of excessive bleeding. If you can, quit smoking, as this will also reduce your risk of abnormal bleeding.
You will typically take one or more enemas the night before and the morning of the procedure. Your doctor will likely have you stop eating and drinking the night before surgery.
Laparoscopic myomectomy typically requires only an overnight stay in the hospital, during which a urinary catheter will likely be inserted. There may be nausea and pain in your shoulder, which is caused by bubbles of carbon dioxide gas becoming trapped against the diaphragm. That and other pain can typically be relieved by over-the-counter pain medication, or prescribed medication by your physician. Light spotting and bleeding can occur in the first few days after the procedure and is normal. Avoid strenuous exercise or intercourse for 4-6 weeks, but light exercise is encouraged in order to avoid blood clotting and build stamina. Fatigue is common in the first few days after surgery, but will subside with time. Patients can return to work 1-7 days after the procedure, but should refrain from strenuous activity.
Although a myomectomy is a relatively low-risk and minimally invasive procedure, risks include excessive bleeding, formation of scar tissue, future complications with pregnancy (requiring C-section), or possible necessity of hysterectomy. As with any surgery performed under general anesthesia, there are risks of anesthesia-related complications or allergic reactions to surgical medications. Recurrence of uterine fibroids may occur in some cases.
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