Laparoscopic myomectomy - when and to whom it is performed?

Laparoscopic myomectomy is an operation performed with uterine myoma. It involves the removal of pathological nodes through punctures or incisions on the abdominal wall. As a rule, it is used when large fibroids are found or when severe myoma complications occur (bleeding, infertility).

Benefits of surgery

One of the most important advantages of laparoscopic (conservative) myomectomy is the preservation of the uterus and all its functions, including menstrual function. Also, a significant advantage is the low traumatic nature of the operation and the rapid recovery of the body after it.

Disadvantages of the operation

The operation to remove the myomatous nodes has only a few, but quite serious drawbacks. The first of these can be called the risk of recurrence of the disease a few years after the operation. The reason for this is the impossibility during the operative intervention to determine the presence of small nodules, which eventually increase in volume. The second disadvantage is the possible damage to nearby internal organs - the intestine, bladder and ureter.

When and to whom is conservative myomectomy shown?

Many doctors advise to resort to this operation only for young women who plan pregnancy in the very near future, and myomatous nodes have increased to such a extent that treatment with medicaments will not give the desired effect. But those ladies who no longer want to have children, it will be more rational to conduct surgery to remove the uterus. After all, in almost all cases of the disease for 5 years, there may be a relapse of the disease.

Also laparoscopic myomectomy is prescribed in cases where there are contraindications to embolization of uterine arteries - insertion of the embolization drug into the vessels through a special catheter through the hip artery puncture.

Laparoscopic myomectomy: contraindications

• Suspicions of a malignant tumor.
• A large number of interstitial nodes, with the removal of which the preservation of reproductive function is impossible.
• The presence of general contraindications to laparoscopy, which can be a threat to the life of a woman.

According to many gynecologists, obesity of 2 and 3 degrees and the presence of adhesions is a contraindication to the operation.

The procedure for performing laparoscopic myomectomy

The essence of this surgery is to pierce the front abdominal wall with a trocar in four places. In one puncture (in the navel area) a laparoscope is inserted, the other three (in the lower abdomen) are surgical manipulators. For a more convenient operation, carbon dioxide is injected into the abdominal cavity . Then the uterine membrane is dissected by a surgical manipulator, and the myomal nodes are removed, and with the help of an electrocoagulator, bleeding stops. The surface where the nodes were located is irrigated with saline, and the nodes themselves are removed, depending on their size: through a puncture (at a small size) where the instruments were inserted, or through a cut dome of the vagina (with a large size). Laparoscopic myomectomy is performed under the influence of general anesthesia. The duration of the entire operation is from 60 to 180 minutes. This type of surgery is very similar to the operation to eliminate a hernia of the abdomen (laparoscopic hernioplasty), which is also performed by piercing the stomach with a thin tube.