Our Summary

This study compared the safety and outcomes of a type of surgery called laparoscopic-assisted myomectomy (LAM), used to treat symptomatic leiomyoma, a type of non-cancerous growth in the uterus. The research compared the results between procedures performed at a standalone surgery center (ASC) and those performed in a hospital outpatient setting. The same surgeons performed the operations at both locations in the Washington, DC area.

The study looked at 816 cases and found that there were similar rates of complications at both the hospital and the surgery center. The average weight of the leiomyomas removed was also similar in both settings. However, the surgery took less time at the surgery center than at the hospital.

The safety protocols were slightly different at the two locations, including the minimum preoperative hemoglobin level (a measure of a patient’s blood health) and the ratio of nurses to patients in the post-anesthesia care unit (PACU). However, the surgical safety standards during the operations were the same.

The study concluded that this type of surgery can be performed safely and effectively at a standalone surgery center by skilled surgeons, even for patients with morbid obesity or large leiomyomas.

FAQs

  1. What is a laparoscopic-assisted myomectomy (LAM) and what conditions does it treat?
  2. Did the study find any difference in the safety and outcomes of LAM performed at a standalone surgery center versus a hospital outpatient setting?
  3. Are the safety protocols and standards the same at both the standalone surgery center and the hospital outpatient setting for LAM procedures?

Doctor’s Tip

A doctor may advise a patient undergoing myomectomy to consider having the procedure done at a standalone surgery center, as the study showed similar rates of complications but shorter surgery times compared to hospital outpatient settings. This can potentially lead to a more efficient and comfortable experience for the patient. Additionally, the study highlighted the importance of skilled surgeons and adherence to surgical safety standards in ensuring a successful outcome for patients, regardless of the location of the procedure.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic leiomyoma, or fibroids, in the uterus. These patients may experience symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or rectum, or infertility. Myomectomy is often recommended for women who wish to preserve their fertility or who prefer a less invasive option compared to hysterectomy.

In this study, the researchers found that laparoscopic-assisted myomectomy was safe and effective for patients with morbid obesity or large leiomyomas, when performed by skilled surgeons. This suggests that myomectomy may be recommended for a wider range of patients than previously thought, including those with more complex cases.

Overall, myomectomy may be recommended for patients who have symptomatic fibroids and wish to preserve their fertility or avoid a hysterectomy. It is important for patients to discuss their options with their healthcare provider to determine the best treatment approach for their individual situation.

Timeline

Before the myomectomy:

  1. Patient consults with their gynecologist or specialist to discuss symptoms and treatment options for symptomatic leiomyoma.
  2. Patient undergoes preoperative testing, such as blood work and imaging studies, to assess their overall health and the size and location of the leiomyomas.
  3. Patient schedules the myomectomy procedure and receives instructions on how to prepare, including fasting and avoiding certain medications.
  4. On the day of the surgery, the patient arrives at the hospital or surgery center and meets with the surgical team to discuss the procedure and address any concerns.

After the myomectomy:

  1. Patient wakes up in the recovery room and is monitored closely for any complications or side effects from the anesthesia.
  2. Patient may experience pain and discomfort in the days following the surgery, which can be managed with pain medication prescribed by the surgeon.
  3. Patient is discharged from the hospital or surgery center once they are stable and able to walk and eat without assistance.
  4. Patient follows up with their surgeon for postoperative care and monitoring of their recovery, including any potential complications such as infection or excessive bleeding.
  5. Patient may experience improvements in symptoms such as heavy menstrual bleeding, pelvic pain, and pressure after the myomectomy, leading to a better quality of life.

What to Ask Your Doctor

  1. What is a myomectomy and why is it recommended for me?
  2. What are the potential risks and complications associated with a myomectomy?
  3. How experienced are you in performing myomectomies, particularly laparoscopic-assisted myomectomies?
  4. What are the differences between having a myomectomy at a standalone surgery center versus a hospital outpatient setting?
  5. What safety protocols are in place at the surgery center where the procedure will be performed?
  6. How long can I expect the surgery to take and what is the expected recovery time?
  7. Will I need any special follow-up care or monitoring after the procedure?
  8. Are there any alternative treatments or procedures that I should consider?
  9. How will the myomectomy affect my fertility and future pregnancies?
  10. What are the chances of the leiomyomas recurring after the surgery?

Reference

Authors: Danilyants N, Mamik MM, MacKoul P, van der Does LQ, Haworth L. Journal: J Obstet Gynaecol Res. 2020 Mar;46(3):490-498. doi: 10.1111/jog.14197. Epub 2020 Jan 29. PMID: 31997510