Our Summary

This research paper is about a surgical technique called laparoscopic myomectomy, which is a minimally invasive surgery used to treat myomas (benign tumors in the uterus). The paper presents this technique in ten easy to follow steps, with the goal of making the procedure safer and simpler. The steps include preparation, ergonomy and material, preventing blood loss, making an incision in the uterus, removing the myoma, stopping bleeding, checking for any remaining myomas, stitching up the incision, removing the myoma from the body, and preventing adhesions (scar tissue). The authors believe that standardizing this technique could help surgeons learn and perform it more effectively. This study was conducted at a French university hospital and did not require patient approval as it focuses on a technique, not a specific clinical case.

FAQs

  1. What is a laparoscopic myomectomy?
  2. What are the ten steps of a laparoscopic myomectomy as outlined in the research paper?
  3. What is the potential benefit of standardizing the laparoscopic myomectomy technique?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the procedure beforehand. It’s important for patients to have a clear understanding of what to expect during and after the surgery, as well as any potential complications that may arise. Additionally, patients should follow their doctor’s instructions for pre-operative preparation and post-operative care to ensure a smooth recovery.

Suitable For

Patients who are typically recommended for a myomectomy are those who have symptoms such as heavy menstrual bleeding, pelvic pain, pressure or fullness in the lower abdomen, frequent urination, or difficulty emptying the bladder. These symptoms are often caused by the presence of myomas in the uterus. In some cases, myomas can also cause fertility issues or complications during pregnancy. Therefore, patients who are experiencing these symptoms and wish to preserve their fertility or improve their chances of a successful pregnancy may be recommended for a myomectomy. Additionally, patients who have myomas that are causing significant discomfort or impacting their quality of life may also be candidates for this procedure. Ultimately, the decision to recommend a myomectomy will depend on the individual patient’s symptoms, medical history, and goals for treatment.

Timeline

Before a myomectomy:

  1. Patient consultation and diagnosis: A patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and infertility, leading them to seek medical attention. A gynecologist may diagnose the presence of uterine fibroids through a physical examination and imaging tests such as ultrasound or MRI.

  2. Pre-operative evaluation: Before the surgery, the patient will undergo a series of pre-operative tests to assess their overall health and suitability for the procedure. This may include blood tests, imaging studies, and possibly a hysteroscopy to further evaluate the fibroids.

  3. Surgical planning: The gynecologist will discuss the surgical options with the patient, including the risks and benefits of a myomectomy versus other treatments such as hysterectomy. A plan will be made for the surgery, including the type of myomectomy (laparoscopic, hysteroscopic, or abdominal) and the potential need for blood transfusions.

After a myomectomy:

  1. Recovery in the hospital: After the surgery, the patient will typically spend a few hours in the recovery room before being transferred to a hospital room. They will be monitored for any complications, such as excessive bleeding or infection, and will receive pain medication as needed.

  2. Post-operative care: The patient will be given instructions on how to care for themselves at home, including managing pain, monitoring for signs of infection, and when to follow up with the gynecologist. They may also be prescribed medications to prevent infection or help with pain.

  3. Follow-up appointments: The patient will need to follow up with their gynecologist for post-operative visits to monitor their recovery and ensure that the fibroids have been successfully removed. Further imaging tests may be done to confirm the success of the surgery.

  4. Long-term outcomes: The patient may experience relief from their symptoms such as heavy menstrual bleeding and pelvic pain following the myomectomy. They may also see improvements in fertility if the fibroids were affecting their ability to conceive. However, there is a risk of fibroid recurrence, so regular follow-up with the gynecologist is important.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the risks and potential complications associated with myomectomy?
  2. What is the expected recovery time following the procedure?
  3. Will my fertility be affected by undergoing a myomectomy?
  4. Are there any alternative treatments or procedures that may be more suitable for my specific case?
  5. How many myomectomies have you performed, and what is your success rate?
  6. What type of anesthesia will be used during the procedure?
  7. Will I need to stay in the hospital overnight after the surgery?
  8. How long will it take for me to resume normal activities and work?
  9. What follow-up care will be required after the myomectomy?
  10. Are there any long-term effects or risks associated with having a myomectomy?

Reference

Authors: Fava V, Gremeau AS, Pouly JL, Chauvet P, Gałczyński K, Botchorishvili R, Bourdel N. Journal: J Minim Invasive Gynecol. 2019 Sep-Oct;26(6):1009-1010. doi: 10.1016/j.jmig.2018.12.021. Epub 2019 Jan 11. PMID: 30639723