Lap Myomectomy (Fibroids) in Thane

A myomectomy is an operation to remove fibroids while preserving the uterus. For women who have fibroid symptoms and want to have children in the future, myomectomy is the best treatment option. Myomectomy is very effective, but fibroids can re-grow. The younger you are and the more fibroids you have at the time of myomectomy, the more likely you are to develop fibroids again in the future. Women nearing menopause are the least likely to have recurring problems from fibroids after a myomectomy.
A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, a laparoscopic myomectomy or a hysteroscopic myomectomy

How is a laparoscopic hysterectomy done?

Only certain fibroids can be removed by a laparoscopic myomectomy. If the fibroids are large, numerous or deeply embedded in the uterus, then an abdominal myomectomy may be necessary. Also, sometimes during the operation it is necessary to switch from a laparoscopic myomectomy to an abdominal myomectomy.
You will be asleep during the procedure, which is performed in the operating room. First, four one-centimeter incisions are made in the lower abdomen: one at the navel (belly button), one below the bikini line (near the pubic hair) and one near each hip. The abdominal cavity is then filled with carbon dioxide gas. A thin, lighted telescope, called a laparoscope, is placed through an incision, allowing doctors to see the ovaries, fallopian tubes and uterus. Long instruments, inserted through the other incisions, are used to remove the fibroids. The uterine muscle is sewn back together. At the end of the procedure, the gas is released and the skin incisions are closed.
Most women spend one night in the hospital and two to four weeks recovering at home. After the procedure, you will have small scars on your skin where the incisions were made.

What preoperative investigations are required?
 A consultation involving full history, assessment of symptoms and clinical examination are necessary along with an ultrasound scan. This scan will delineate the number, size and location of fibroids. Occasionally, an MRI scan may be required especially if adenomyosis is suspected. (Adenomyosis is a condition where uterus is enlarged due to infiltration of uterine lining into the muscle layer. It leads to heavy and painful periods and sometimes can be mistaken for a fibroid uterus).

What about preoperative medical treatment to shrink fibroids?
 GnRH analogues can be administered as a monthly or three-monthly intramuscular injection. This therapy usually leads to significant shrinkage in size of fibroids and can make even larger fibroids amenable for laparoscopic surgery. They have also been shown to reduce blood loss and surgical duration. The periods will usually stop while you are on these injections thus allowing the haemoglobin to build up. These injections sometimes can cause side-effects of hot flushes and night sweats. They can also make small fibroids undetectable at the time of surgery which may grow back afterwards. The use is therefore reserved in cases where there is anaemia due to heavy periods and when the fibroids are larger than 16 weeks of pregnancy.

What incisions are made?
 Generally 3 or 4 small incisions are made on the abdomen depending on the uterine size and other circumstances. One 12mm incision is made within the umbilicus and the remaining incisions are smaller (5mm).

How are the fibroids removed through such small incisions? A special device called morcellator is used to cut the fibroid into smaller pieces which are then extracted out through a smaller incision.