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Laparoscopic myomectomy is a minimally invasive surgical procedure used to remove uterine fibroids while preserving the uterus. It involves making small incisions in the abdomen and utilizing specialized instruments and a laparoscope to excise the fibroids. This can be done either in laparoscopic or hysteroscopic methods.

Purpose Of The Procedure

Laparoscopic myomectomy serves several purposes:

Fibroid Removal

To surgically remove symptomatic uterine fibroids causing issues such as heavy menstrual bleeding, pelvic pain, or pressure on nearby organs.

Symptom Relief

Alleviating symptoms associated with fibroids, like heavy bleeding and pain.

 

 

Preservation Of Uterine Function

Maintaining the integrity of the uterus, important for women who want to retain fertility or avoid a hysterectomy.

Improved Fertility

Enhancing fertility for those experiencing infertility due to fibroids.

 

 

Minimally Invasive Approach

Offering a less invasive alternative to open surgery, which often results in quicker recovery and less noticeable scarring.

When Should It Be Performed

Laparoscopic myomectomy is typically considered when:

  • A woman experiences symptomatic uterine fibroids, such as heavy menstrual bleeding, pelvic pain, or pressure on adjacent organs.
  • Fibroids are causing infertility issues.
  • The patient prefers to preserve the uterus or wishes to avoid open surgery.

What is expected to be performed

During laparoscopic myomectomy when:

  • Small abdominal incisions are made (typically less than 1 cm each).
  • A laparoscope with a camera is inserted to visualize the surgical area.
  • Specialized instruments are used to locate, isolate, and remove the fibroids.
  • Uterine incisions are meticulously sutured to ensure proper closure.
  • In addition to the above  mentioned steps, the surgeon may also take any additional measures they deem necessary at that point of time
Anesthesia

General anesthesia is typically administered to ensure the patient remains unconscious and pain-free throughout the procedure.

Incisions

Several small, minimally visible incisions are made in the abdominal wall to provide access to the surgical site. The number and location of these incisions depend on the surgical approach.

Surgical Instruments And Equipment

Instruments may include laparoscopes, trocars, graspers, scissors, and electrosurgical devices, enabling precise dissection and removal of fibroids.

Duration Of Surgery

The length of the surgery can vary based on factors like the number, size, and location of the fibroids. Typically, laparoscopic myomectomy takes around 1 to 3 hours on average.

Intraoperative Monitoring

Various monitoring equipment, including ECG and blood pressure monitors, is employed to ensure the patient's safety during the surgery.

Potential Complications

Potential complications may include:

  • Bleeding during or after surgery.
  • Infection at incision sites or within the pelvic cavity.
  • Injury to adjacent structures, although this is rare.
  • Formation of scar tissue (adhesions).

Expected Outcomes

Expected outcomes of laparoscopic myomectomy include:
  • Relief from fibroid-related symptoms.
  • Preservation of the uterus for future pregnancies.
  • Enhanced fertility for individuals experiencing fibroid-related infertility.
  • Smaller, less noticeable scars compared to open surgery.

– Alternatives to Surgery

Alternatives may include watchful waiting, medical management, or other minimally invasive treatments like uterine artery embolization (UAE) or MRI-guided focused ultrasound.

– Scarring

Laparoscopic myomectomy typically results in small, discreet scars at the incision sites, which may fade over time.

Post-Operative Care

Post-operative care involves:

  • Pain management.
  • Activity restrictions, particularly avoiding strenuous activities and heavy lifting.
  • Follow-up appointments for monitoring and assessment.
  • Dietary considerations as advised.
  • Instructions for incision care.

– Hospital Stay

While many patients undergo laparoscopic myomectomy as an outpatient procedure, some may require an overnight stay, depending on the extent of fibroid removal and individual recovery needs.

Recovery Time Post-Surgery

After a laparoscopic myomectomy, the expected recovery time can vary depending on several factors, including the size and number of fibroids removed, the patient's overall health, and individual healing abilities. Here's a general overview of the recovery process:

1. Immediate Post-Operative Period:

  • Patients are typically monitored in a recovery area for several hours following the surgery.
  • Pain management is initiated to ensure comfort.

2. Hospital Stay:

  • In many cases, laparoscopic myomectomy is performed as an outpatient procedure, and patients can go home on the same day.
  • However, some patients may require an overnight hospital stay, especially if multiple or large fibroids were removed.

3. Pain And Discomfort:

  • It's common to experience some pain and discomfort after the surgery, which can be managed with prescribed medications.
  • Pain levels usually peak within the first 24 to 48 hours and gradually improve.

4. Activity Restrictions

  • Patients are typically advised to avoid strenuous activities, heavy lifting, and vigorous exercise for several weeks (usually 4 to 6 weeks) to allow for proper healing.
  • walking and gentle movements are encouraged to prevent blood clots and promote circulation.

5. Dietary Considerations

  • Patients may receive dietary guidelines, such as avoiding heavy or spicy foods immediately after surgery.
  • Gradually, patients can return to their regular diet as tolerated.

6. Follow-Up Appointments

  • Regular follow-up appointments with the surgeon are important to monitor healing progress and address any concerns.
  • The first follow-up appointment is typically scheduled within 1 to 2 weeks after the surgery.

7. Resuming Normal Activities:

  • Most patients can return to work or normal daily activities within 1 to 2 weeks, but this can vary based on individual recovery.
  • Activities that involve heavy lifting or strenuous exercise may require more time before resumption.

8. Scar Healing:

  • The small incisions made during laparoscopic myomectomy usually result in minimal scarring.
  • Scars will continue to fade over several months, and patients can apply scar-reducing creams or oils as recommended by their surgeon.

9. Full Recovery:

  • A full recovery from laparoscopic myomectomy may take several weeks to a few months.
  • It's important for patients to follow their surgeon's instructions regarding activity restrictions and medication.

10. Return To Fertility:

  • If fertility preservation was a goal of the procedure, it's essential to discuss with the healthcare provider when it's safe to resume attempts at conception. This timing can vary from patient to patient.

Patients should communicate openly with their healthcare team throughout the recovery process, reporting any unusual symptoms or concerns promptly. Each individual's recovery experience is unique, and Dr Vindhya G will provide personalized guidance based on the patient's specific circumstances.

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