Laparoscopic/Hysteroscopic Myomectomy

Many women have benign tumors in their uterus called myomata uteri or fibroids. These myoma may be silently present and cause no problems. In many women, however, fibroids can cause excessive and frequent menstrual periods, pelvic pain, infertility and recurrent pregnancy loss. Severe anemia can result from excessive uterine bleeding. Other symptoms can include pelvic pressure on the woman's bladder or rectum which may result in frequent urination or constipation. And finally, some women will experience pain during sexual intercourse (dyspareunia) due to their enlarged uterus from fibroids.

Until recently, if surgical removal of fibroids was necessary, it almost always involved a large abdominal incision (laparotomy) with a 3-5 day hospital stay and 6-8 week recovery. Now, for many women facing removal of their fibroids (myomectomy) or removal of their uterus (hysterectomy) , there is new alternative involving a laparoscopic or hysteroscopic approach.

Laparoscopic myomectomy takes place under general anesthesia, unless a new gasless technique is used, in which case a regional (epidural) anesthesia may be employed. Several small 1/2 inch incisions in the abdominal wall are used in order to place the laparoscope and other instruments. Then, using techniques such as laser, argon beam coagulation, or electrosurgery, the fibroids can be removed and the uterine wall repaired. A recently introduced technique for laparoscopic myomectomy involves using a bipolar needle or laser to perform "myolysis" of the fibroids. This does not involve surgically cutting into the uterus, but instead, it uses either electrical current or laser energy to coagulate the fibroids, resulting in their shrinking by 50% after surgery.

Hysteroscopic myomectomy is performed through the woman's cervical canal and does not involved any abdominal incisions. A device called a resectoscope can be used to either cut away the fibroids or electrical current can be used to "evaporate" the fibroids. With both a laparoscopic and/or hysteroscopic myomectomy, the patient goes home the same day of surgery. Most women are back to normal activities within 7-10 days.

While most laparoscopic/hysteroscopic myomectomies proceed without difficulty, there is always the possibility that a more conventional incision in the abdomen may be necessary to safely complete the surgical procedure. As with any other surgical procedure, there are also risks of bleeding, blood transfusion, infection, anesthetic complications or injury to other structures such as bowel or bladder. Fortunately, these risks are seldom encountered. For women later becoming pregnant, there is the possible need of a Cesarean Section being required for delivery because of weakening of the uterine wall from the myomectomy. And finally, fibroids may recur in women who have undergone a previous myomectomy.

In summary, the advantages of laparoscopic/hysteroscopic myomectomy are a shorter hospital stay (1 day), reduced recovery time and reduced post-operative pain, smaller incisions, better cosmetic results, and a lower cost for the patient and/or their insurance company.