Laparoscopic Myomectomy

 

What Is Laparoscopic Myomectomy?

A laparoscopic myomectomy is a minimally invasive surgery used to remove uterine fibroids (leiomyomas) while preserving the uterus. It is often chosen by women who wish to maintain fertility or want to keep their uterus for personal or medical reasons.

The surgeon makes small abdominal incisions and uses a laparoscope (a thin camera tube) and specialized instruments to remove fibroids with precision and minimal tissue trauma.

Why Is It Done? (Indications)

Laparoscopic myomectomy is recommended for women with symptomatic fibroids causing:

• Heavy menstrual bleeding

• Pelvic pain or pressure

• Infertility or recurrent pregnancy loss due to fibroids

• Urinary frequency or constipation caused by fibroid size

• Rapidly enlarging fibroids (after evaluating malignancy risk)

• Desire to preserve the uterus

Types of Fibroids That Can Be Removed

• Intramural: Within the uterine wall

• Subserosal: Bulging outward from the uterus

• Pedunculated: Attached by a stalk

• Selected submucosal fibroids (depending on size/location), though these are often removed hysteroscopically

How the Procedure Works

1. Small incisions are made in the abdomen.

2. CO₂ gas is used to inflate the abdomen for visibility.

3. A laparoscope and instruments are inserted.

4. Fibroids are located and the uterine muscle is incised.

5. Fibroids are carefully removed, often in pieces (morcellation) if large.

6. The uterine muscle is sutured in multiple layers to restore strength.

7. The abdomen is cleansed and incisions are closed.

Benefits

• Smaller incisions and minimal scarring

• Less postoperative pain

• Reduced blood loss compared to open surgery

• Faster recovery (1–3 weeks)

• Preservation of fertility

• Shorter hospital stay (often same day or one night)

Possible Risks

• Bleeding

• Uterine scarring or adhesions

• Injury to nearby organs (bladder, bowel, vessels)

• Fibroid recurrence (fibroids may grow again)

• Rare need for conversion to open surgery

• Potential for uterine rupture in future pregnancy (depends on depth/size of incisions)

Recovery After Surgery

Most patients:

• Walk on the same day

• Resume normal activities within 1–2 weeks

• Experience temporary shoulder-tip pain from CO₂ gas

• Need to avoid heavy lifting and strenuous activity for 4–6 weeks

• Are advised to delay pregnancy for 3–6 months to allow full uterine healing

Who Is a Good Candidate?

Ideal candidates typically have:

• A moderate number of fibroids

• Fibroids sized generally up to 8–10 cm (surgeon-dependent)

• Minimal to moderate pelvic adhesions

• Desire for future fertility

• Normal overall health allowing for minimally invasive surgery