Laparoscopic myomectomy is an invasive surgical procedure that involves the removal of uterine fibroids. These fibroids are non-cancerous growths that appear in the uterus, often during childbearing years. This procedure is a minimally invasive alternative to open surgery and is often recommended when the fibroids are causing significant symptoms or complications such as heavy bleeding, pelvic pain, or infertility. The laparoscopic myomectomy procedure uses a laparoscope, a thin tube with a camera attached, and other small instruments that are inserted through tiny incisions in the abdomen to remove the fibroids. 

This is the most common type of laparoscopic myomectomy procedure. The surgeon makes a small incision in the navel and inserts the laparoscope, which sends images to a monitor to give the surgeon a detailed view of the uterus and surrounding organs. Additional small incisions are made for the specialized surgical instruments used to remove the fibroids. 

Standard Laparoscopic Myomectomy 

In this procedure, the surgeon uses a computer to control the surgical instruments, which are inserted through small incisions in the patient's abdomen. The computer translates the surgeon's hand movements into finer, precise movements of the instruments inside the body. This allows for enhanced precision, flexibility and control during the operation. 

Robotic-Assisted Laparoscopic Myomectomy 

This procedure is used for fibroids that are mostly inside the uterine cavity. The surgeon accesses and removes fibroids with the help of instruments inserted through the vagina and cervix, eliminating the need for incisions in the abdomen. The fibroids are viewed and removed by inserting a hysteroscope in the uterus via the cervix. 

Hysteroscopic Myomectomy 

This procedure combines features of both laparoscopic and open surgery. It is often used for removing large or numerous fibroids. The fibroids are removed through a larger incision in the abdomen, while the laparoscope helps the surgeon see the pelvic organs. 

Laparoscopic-Assisted Myomectomy (LAM) 

Types of Laparoscopic Myomectomy Procedure 

A Laparoscopic Myomectomy operation is typically required when a woman has symptomatic uterine fibroids. These are non-cancerous growths that arise from the muscle cells of the uterus. While many fibroids do not cause symptoms, some women may experience heavy menstrual bleeding, pelvic pressure or pain, and fertility challenges. 

This surgical procedure is particularly beneficial for women who wish to retain their fertility. Unlike a hysterectomy, which involves the removal of the entire uterus, laparoscopic myomectomy only removes the fibroids, leaving the uterus intact. This allows women the potential opportunity to conceive in the future. 

Another scenario where Laparoscopic Myomectomy may be required is when fibroids are causing discomfort or pain, disrupting a woman's daily activities. This can occur when fibroids grow large enough to press on other organs or structures within the pelvic region. In such cases, removing the fibroids can alleviate the discomfort and improve the woman's quality of life. 

When is Laparoscopic Myomectomy Operation Required? 

Before the surgery, your doctor will do a thorough medical evaluation. This includes a pelvic examination, ultrasound or magnetic resonance imaging (MRI) to determine the size, location, and number of fibroids. Blood tests may also be required to assess your overall health condition and ensure that you are eligible for surgery. 

It is important to discuss with your doctor any medicines, herbal remedies or supplements you are on, as some of these may need to be stopped before your surgery. For example, medications that thin the blood should be discontinued to lower the risk of excessive bleeding during surgery. 

In preparation for the surgery, the doctor may prescribe medications to shrink the size of the fibroids. This can make the operation less complicated and reduce blood loss during the procedure. These medications are usually given for a few weeks to months before the operation. 

Lastly, ensure you have arranged for someone to drive you home after the operation, as you will not be in a condition to drive yourself. Also, plan for a recovery period at home, where you will need to rest and avoid strenuous activities for a few weeks post-operation. 

How to Prepare for Laparoscopic Myomectomy Surgery? 

Before laparoscopic myomectomy surgery, your doctor will conduct a preoperative assessment to check your overall health status. This usually involves a thorough physical examination, medical history review, and various laboratory tests such as blood tests and imaging studies. 

You will need to finish your last meal 12 hours before the procedure and stop eating and drinking a minimum of 12 hours preoperatively to prepare your body for anesthesia. It is also important to inform your doctor about your current medication as some of it might need to be discontinued prior to the surgery. 

Your doctor will give detailed instructions on what to do on the day of the surgery. This includes arriving at the hospital early, wearing comfortable clothing, and bringing a friend or a relative to drive you home after the procedure. 

In addition, you may need to undergo bowel prep before surgery. This involves consuming a special liquid diet and taking laxatives to clear your bowel. This is necessary to reduce the risk of infection during the surgery. 

Lastly, your doctor will discuss with you the risks and benefits of surgery. You will also need to sign a consent form. This is done so that you understand the procedure and agree to undergo it. 

What Happens Before Laparoscopic Myomectomy Surgery? 

During a laparoscopic myomectomy operation, you will be put under general anesthesia, which means you will be asleep and won’t feel any pain during the procedure. 

Your surgeon will make a small cut near your belly button and insert a laparoscope, which is a thin tube with a light and camera on the end. This allows your surgeon to see your uterus and surrounding organs clearly on a monitor. 

Your abdomen will be inflated with a harmless gas (carbon dioxide) to create space for the surgeon to work. Then, a few more small incisions will be made to insert other surgical instruments. 

Your surgeon will use these instruments to remove the fibroids from your uterus. The size and location of the fibroids will decide how they are removed. Small fibroids can often be removed intact while larger ones may need to be cut into smaller pieces before removal. 

Once all the fibroids are removed, your surgeon will securely close the incisions using stitches or surgical glue. The gas in your abdomen will be removed and you shall be moved to the recovery room. 

What Happens During Laparoscopic Myomectomy Operation? 

Laparoscopic myomectomy is a minimally invasive procedure performed under general anesthesia. The surgeon makes a small incision in the navel and inserts a laparoscope, a thin, lighted tube with a camera, to view the uterus and surrounding region. 

Additional small incisions are made for the insertion of specialized surgical instruments. These instruments are used to carefully separate the fibroids from the normal uterine tissue. 

The fibroids are then cut into small pieces and removed through the small incisions. In some cases, a technique called morcellation is used where the fibroids are ground up inside the body and then removed. 

Once all fibroids have been removed, the surgeon closes the incisions with stitches. The procedure is generally completed in 1-3 hours depending on the size and number of fibroids. 

Methods/Techniques used for performing laparoscopic myomectomy procedure 

After the procedure, the patient is monitored in the recovery room for a few hours before being discharged. Pain medication is usually provided to manage any discomfort. 

Patients are usually able to return to their regular activities within 2-4 weeks. They should not lift heavy objects or engage in strenuous physical activity during this recovery period. 

Follow-up visits are set up in order to monitor healing and recovery. In some cases, an ultrasonography or MRI may be performed to ensure all fibroids have been successfully removed. 

Most women experience significant relief from fibroid symptoms after a laparoscopic myomectomy. However, new fibroids can develop in the future, necessitating additional treatment. 

Post Procedure details 

As with any surgery, laparoscopic myomectomy carries risks including infection, bleeding, and complications from anesthesia. There is also a risk of damage to the organs located nearby, like the bladder or bowel. 

During the procedure, if the surgeon encounters unexpected difficulties, it may be necessary to convert to an open surgical procedure. This would result in a larger incision and longer recovery time. 

The use of morcellation carries specific risks including the spread of undetected cancerous cells if a fibroid is malignant. However, the incidence of this is extremely low. 

There is a small risk of recurrence of fibroids after a myomectomy. In some cases, a hysterectomy may be recommended if fibroids continue to grow back.

Risks and complications associated with laparoscopic myomectomy surgery 

Cost of Laparoscopic myomectomy in Major Cities in India

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