Laparoscopic myomectomy is done usually for the treatment of infertility.
They are submucosal ,intramural ,subserosal or pedenculated.
Clinical examination and
fibroids are usually asymptomatic, discovered accidentally on per vaginal examination or ultrasound.
If symptomatic, they are to be treated.
Menorrhagia can be controlled medically with tranexamic acid, mefenemic acid,progestogens, Mirena IUS and GnRh analouges.
Gynecologists prefer hysterectomy if woman is having troublesome symptoms and has completed her family.Hysterectomy gives higher satisfaction rate.
Myomectomy is the treatment for woman who wishes to conserve her uterus for the fertility.
Disadvantages are that sometimes they form a dense fibrous sheath around the fibroid. Its use has been reserved only for the very large myomas.
Most important part is planning of the incision.It is made using harmonic scalpel or diathermy armed scissors or needle electrode.
The serosa and myometrium is incised till the pseudocapsule is identified and then it is extended.Fibroid is manipulated using myoma screw, one designed by Dr Rakesh Sinha has a better tissue grip and better strength.The procedure is surprisingly bloodless even without pitressin if the surgeon is in the right plane.
Defect is repaired in 2 layers , interrupted 2/0 vicryl for the myometrium and 3/0 for the serosa is used. Knots can be tied extracorporeally or intracorporeally.
Dr Prakash Trivedi ties first one extra and the subsequent ones intracorporeally.
Removal of the fibroids from the peritoneal cavity
- Buttram VC, Reiter RC . Uterine Leiomyoma ; etiology. symptomatology and magement, Fertil Steril 1981;10 10:433-445
- Picture from BEAMS Mumbai (fibroids)
- Fibroids (bupa.com.au)
- When Uterine Fibroids Become Problematic (everydayhealth.com)
- Does embolization get rid of uterine fibroids? (zocdoc.com)
- GYN Oncologist Uses da Vinci Surgical Robot to Preserve Fertility (prweb.com)
- Total laparoscopic hysterectomy (bhagia.wordpress.com)