Thursday, December 29, 2011

Laparoscopic Myomectomy

The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. The disadvantage is that only small fibroids can be removed by laparoscopic myomectomy and it is not recommended if there are many fibroids or if the fibroids are deeply embedded in the uterine wall. Laparoscopic surgery is usually performed as out-patient surgery under general anesthesia. The procedure can take one to three hours, depending on the number, size, and depth of the fibroids within the muscle wall. Following laparoscopic myomectomy many women are able to leave the hospital the same day, although a one-night stay may be necessary. Because the incisions are small, recuperation is usually associated with minimal discomfort. After laparoscopic myomectomy, women usually return to normal activity within ten to fourteen days.

During this procedure a laparoscope (a thin fiber-optic device that transmits light and a video image) is inserted through a small incision, usually in the navel, to view the uterus. The image from the camera attached to the end of the laparoscope is seen on a video monitor. Two or three small (half-inch) incisions are made below the public hairline and instruments are inserted through these incisions to perform the surgery. The fibroids are detached from the uterus and removed. Following removal of the uterine fibroids, the openings in the uterus are stitched closed with the use of specially designed instruments.

Not all surgeons are trained in laparoscopic surgery; because of the small size of the incisions, removing uterine fibroids with laparoscopic myomectomy requires special training. Fibroids that are attached to the outside of the uterus by a stalk (pedunculated fibroids) are the easiest to remove laparoscopically. Many subserous fibroids (close to the outer surface) can also be removed through the laparoscope. There is a risk of leaving small fibroids untreated if there are multiple fibroids being removed by laparoscopic myomectomy.

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