Kurt Semm one of the leading innovators of his time is credited as performing the first laparoscopic myomectomy in the 1970s
Since then laparoscopic myomectomy has become a mainstay treatment for selected women with uterine fibroids, with its proven advantages as a minimal access surgical technique.
Women require less pain relief. In most cases it takes longer to perform than open surgery but women t return to normal activities quicker. It is associated with less blood loss, and less adhesion formation (formation of scar tissue).
Factors limiting the availability of this therapy to most women is surgeon training and skill but having said that it is not the operation of choice for all. But where feasible it should be offered.
Traditionally laparoscopic myomectomy used to be limited to women with fibroids of 5cm or less, ideally the fibroids would have been subserous or intramural and not more than 3 in number.
With increasing technological advancement it is now possible to manage deep intramural or submucous fibroids laparoscopically. In fact in medical literature there are reports of fibroids of up to 15cm being removed laparoscopically.
The advantages of laparoscopic surgery to open surgery for women with fibroids includes:
Less Adhesion formation:
Adhesions are defined as scar tissue that results from the body healing itself. Tissues that are in proximity to each other during the healing process tend to stick together.
More than 90% of women who have myomectomy will develop adhesions. In 30% of these women they may be significant and lead to intestinal obstruction, chronic pain. If the adhesions involve the fallopian tubes or distort the pelvic anatomy they can lead to infertility
Laparoscopic surgery for the treatment of fibroids decreases adhesion formation by half and the adhesions tend to be less dense and less significant.
Less Blood loss:
Myomectomy is potentially a very bloody operation. This of course depends on the number and the location of fibroids. The greater the number of fibroids and the deeper the fibroids the greater the bleeding.
In my personal series there is about a 1:50 risk of needing a blood transfusion. With open surgery the risk can be as high as 1:20
Hospital stay:
After laparoscopic myomectomy the majority of women stay in hospital for 1-2 days
Return to normal activity
Recovery after any sort of surgery depends on the individual level of fitness and health before surgery.
Depending on the number of fibroids removed and the difficulty of the procedure the majority of women are able to return to 50-75% of their normal activity within 1-2 weeks. Women who work from home should be able to do this within 2 weeks.
By the 4th week women should be able to return to most of the activities they used to enjoy before surgery and by 6 weeks they should be able to return to the Gym.
After open surgery the above figures are usually doubled.
Since then laparoscopic myomectomy has become a mainstay treatment for selected women with uterine fibroids, with its proven advantages as a minimal access surgical technique.
Women require less pain relief. In most cases it takes longer to perform than open surgery but women t return to normal activities quicker. It is associated with less blood loss, and less adhesion formation (formation of scar tissue).
Factors limiting the availability of this therapy to most women is surgeon training and skill but having said that it is not the operation of choice for all. But where feasible it should be offered.
Traditionally laparoscopic myomectomy used to be limited to women with fibroids of 5cm or less, ideally the fibroids would have been subserous or intramural and not more than 3 in number.
With increasing technological advancement it is now possible to manage deep intramural or submucous fibroids laparoscopically. In fact in medical literature there are reports of fibroids of up to 15cm being removed laparoscopically.
The advantages of laparoscopic surgery to open surgery for women with fibroids includes:
Less Adhesion formation:
Adhesions are defined as scar tissue that results from the body healing itself. Tissues that are in proximity to each other during the healing process tend to stick together.
More than 90% of women who have myomectomy will develop adhesions. In 30% of these women they may be significant and lead to intestinal obstruction, chronic pain. If the adhesions involve the fallopian tubes or distort the pelvic anatomy they can lead to infertility
Laparoscopic surgery for the treatment of fibroids decreases adhesion formation by half and the adhesions tend to be less dense and less significant.
Less Blood loss:
Myomectomy is potentially a very bloody operation. This of course depends on the number and the location of fibroids. The greater the number of fibroids and the deeper the fibroids the greater the bleeding.
In my personal series there is about a 1:50 risk of needing a blood transfusion. With open surgery the risk can be as high as 1:20
Hospital stay:
After laparoscopic myomectomy the majority of women stay in hospital for 1-2 days
Return to normal activity
Recovery after any sort of surgery depends on the individual level of fitness and health before surgery.
Depending on the number of fibroids removed and the difficulty of the procedure the majority of women are able to return to 50-75% of their normal activity within 1-2 weeks. Women who work from home should be able to do this within 2 weeks.
By the 4th week women should be able to return to most of the activities they used to enjoy before surgery and by 6 weeks they should be able to return to the Gym.
After open surgery the above figures are usually doubled.
Educational video depicting actual surgery for a fibroid located on the posterior aspect of the uterus (video contains actual surgery)
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