Leiomyoma is the most common benign tumor in women of reproductive age, and laparoscopic myomectomy has proven its effectiveness compared to other methods for treating these tumors in Turkey.
The uterus is one of the most common sites for the development of cancers, whether benign or malignant, so surgical and medical methods have varied and differed, and many qualitative leaps have emerged in the treatment of diseases of this organ, especially since it has an important function in carrying fetuses and preserving the human species.
What is a leiomyoma?
Leiomyoma is a benign tumor in the thick middle layer of the uterine wall. It is the muscle layer (arising from the uterine muscles) that contracts during labor and menstruation, and it often appears in the years of reproductive activity for women.
It is very rare for these tumors to develop into malignant tumors, but in some cases (30% of cases), they can cause many symptoms in those affected. This tumor is one of the most common tumors among the benign uterine tumors that are widespread in women.
These tumors vary greatly in size, and the patient may have more than one tumor in different areas of the uterine muscle. These tumors increase the risk of miscarriage or spontaneous abortion in patients and may cause infertility in them.
This tumor is also called Fibroid, which is a broader term that includes fibroids and muscle tumors that typically arise in the uterine wall, so this procedure can be called Laparoscopic Myomectomy.
What surgeries are usually performed to remove uterine myomas?
Uterine myomas removal (or Fibroids Removal) surgery is called Myomectomy.
There are several ways in which this surgery can be performed, which are:
- Open Abdominal Myomectomy: In this, the doctor makes a surgical incision in the lower abdomen (the incision is usually horizontal) to reach the uterus and remove the tumor.
- Laparoscopic Myomectomy: This is what we will talk about in detail later in the article.
- Robotic Myomectomy: It is very similar to the laparoscopic myomectomy method, except that the doctor sits away from the patient and controls robotic tools via a remote control, allowing greater access to the tumor and a clearer view.
- Hysteroscopic Myomectomy: The doctor removes the tumor by inserting a laparoscope (with other medical tools) into the vagina and through the cervix until it reaches the tumor site.
There are several other highly effective non-surgical treatments for this tumor in Turkey, such as treating fibroids (muscles) using a catheter.
When do we perform laparoscopic uterine cancer removal instead of other methods?
Laparoscopic surgery has several advantages over other methods, including:
- Less pain, less blood loss, and control
- Much fewer aesthetic problems compared to using open abdominal removal
- Fewer adhesions
- Faster recovery after surgery compared to other methods
- The patient does not need to stay in the hospital for more than one night
However, laparoscopic uterine myoma surgery cannot be used in all cases, as there are conditions that must be met for this surgery to achieve the best results. These include:
- The uterus must have good mobility that allows for maneuvering
- The diameter of the tumor must not exceed 10 cm at most (of course, there are exceptions depending on the case and the patient)
- There must be no more than 5 fibroids
- There must be a sufficient surgical area for the surgical operation, and the tumor must not be deep enough to make removal difficult
Who are the candidates for laparoscopic myomectomy?
Any patient who complains of symptoms resulting from the presence of these tumors or if the tumor has caused many previous miscarriages or affected her daily and sexual activity is a candidate for laparoscopic myomectomy.
Laparoscopic myomectomy is also suitable for patients who want to have children in the future or do not want to have a complete hysterectomy (as is the case with many treatment solutions) for other reasons.
Symptoms that may appear in patients with these tumors include:
- Severe pelvic or abdominal pain that does not go away on its own
- Bleeding outside of menstruation
- A disturbed menstrual cycle (longer or shorter)
- Difficulty urinating or urinary incontinence in some cases
- Unexplained anemia
Preoperative preparations
If the patient decides to undergo the operation, she must see the surgeon before the operation to inform her of the necessary preparations. The doctor must be informed of the type of medications the patient is taking, whatever they are (vitamins, supportive medications, etc.), and the doctor determines which medications should be stopped. The patient is told to stop eating and drinking a few hours before the operation (usually midnight the night before the operation).
Medications may be given to shrink the tumor, such as medications known as gonadotropin-releasing hormone agonists. Iron supplements may also be given to prevent heavy bleeding and treat anemia.
Various tests are performed to determine whether the patient is ready for surgery, including:
- Abdominal ultrasound
- MRI
- Certain blood tests
- ECG
How is laparoscopic myomectomy performed?
The procedure can be performed under general anesthesia for the patient or under anesthesia for the abdominal area only, depending on the duration of the procedure, the patient’s desire, and several other factors, but general anesthesia is usually preferred.
First, four small incisions, one centimeter (or half an inch) in diameter, are made in the lower abdomen. These incisions are distributed: one is near the navel, the other near the pubic hair, and an incision is made near each hip. Then, the abdominal cavity is filled with carbon dioxide gas (CO2) to help the surgeon see inside the abdomen.
The doctor inserts a laparoscope, which is a thin tube with a light and camera at the end (called a laparoscope), through one of the incisions, where the laparoscope allows the ovaries, fallopian tubes, and uterus to be seen.
In case the tumors are large, a specific tumor-cutting tool called a Morcellator is used. This device cuts the uterine myoma into small pieces (fitting the size of the incisions made) that the doctor can remove using medical tools inserted through the other incisions.
The uterine muscle is sutured at the site of the tumor removal, and at the end of the procedure, the injected gas is released, and the surgical incisions are sutured. The operation usually takes less than three hours.
The doctor may change the surgical route and course to open abdominal myomectomy if the tumor removal is difficult and the operation takes a long time.
In robotic myomectomy surgery, the same steps are performed, except that the doctor controls a robotic hand remotely to replace him in the operation.
Read about: Uterine prolapse: Discover the causes and effective treatment and prevention methods
If you find the steps of the procedure difficult to understand or want to ask about its cost, do not hesitate to contact us, the center of your family in Turkey.
Complications and post-operative complications
As with any minimally invasive procedure, laparoscopic myomectomy has several complications, although they are rare, including:
- Infection at the site of the surgical incisions
- Anesthetic problems resulting from the patient’s body not being compatible with the medication
- Severe bleeding (very rare due to the minimally invasive surgery and small incisions)
- Formation of clots after the procedure
- Injury to adjacent organs inside the abdomen
- Incomplete removal of the tumor, which leads to its growth again and the recurrence of symptoms in the patient
As we have seen, complications of myomectomy are rare and are no more than the least complicated surgery. As for recovery, the patient usually does not stay in the hospital for more than one night. The patient recovers from the surgery after two or three weeks at most.
The patient will feel some pain and may have light intermittent vaginal bleeding, so the doctor will give painkillers to improve the patient’s condition and psychological state. You should wait for two or three weeks before doing some strenuous work or sexual intercourse in case of bleeding or tearing of the surgical sutures.
Sources:
