Our Summary

This research paper is a comprehensive review of studies comparing two methods of removing fibroids, noncancerous growths in the uterus. The two methods are laparoscopic myomectomy (LMy), a minimally invasive surgery using a small incision and a camera, and open conservative myomectomy, a traditional surgery involving a larger incision.

The review found that LMy has several advantages over the traditional method, such as less blood loss, fewer cases of post-operative fever, less pain 48 hours after surgery, and fewer requests for pain medication. LMy was also associated with fewer complications like adhesions, which are bands of scar tissue that can cause organs to stick together.

However, the review did not find significant differences between the two methods in terms of blood loss or pain 24 hours after surgery. Also, it couldn’t draw conclusions regarding the use of specific preventive measures due to insufficient data.

The conclusion is that, when performed by a well-trained surgeon and for the right reasons, LMy is the more preferable method as it results in better clinical outcomes and fewer complications compared to the traditional method.

FAQs

  1. What are the two methods of removing fibroids discussed in the research paper?
  2. What benefits does the laparoscopic myomectomy (LMy) have over the traditional open conservative myomectomy?
  3. Does the research paper find any significant differences in blood loss or pain 24 hours after surgery between the two methods?

Doctor’s Tip

A helpful tip a doctor might give a patient about myomectomy is to discuss with their surgeon the option of laparoscopic myomectomy as it may result in less blood loss, reduced pain, and fewer complications compared to open conservative myomectomy. It is important for patients to have a thorough discussion with their healthcare provider about the benefits and risks of each method to determine the best treatment option for their individual case.

Suitable For

Patients who are typically recommended for myomectomy are those with symptomatic fibroids, such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, or infertility issues. Myomectomy is often recommended for women who wish to preserve their fertility and have not responded to other treatment options. Additionally, myomectomy may be recommended for patients who have fibroids causing complications such as recurrent miscarriages or preterm labor.

It is important for patients to discuss their individual situation with their healthcare provider to determine if myomectomy is the best course of treatment for them. Factors such as the size, number, and location of the fibroids, as well as the patient’s overall health and reproductive goals, will be taken into consideration when making this decision.

Timeline

Before a myomectomy:

  • Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, frequent urination, and abdominal swelling due to fibroids in the uterus.
  • Patient may undergo imaging tests such as ultrasound or MRI to confirm the presence and location of the fibroids.
  • Patient may discuss treatment options with their healthcare provider, including the possibility of a myomectomy to remove the fibroids while preserving the uterus.

After a myomectomy:

  • Patient will undergo the chosen surgical procedure, either LMy or open conservative myomectomy, under general anesthesia.
  • Patient may experience some pain and discomfort after the surgery, which can be managed with pain medication.
  • Patient will typically stay in the hospital for a few days for monitoring and recovery.
  • Patient will be advised to avoid heavy lifting and strenuous activities for a few weeks after the surgery.
  • Patient will have follow-up appointments with their healthcare provider to monitor their recovery and discuss any concerns or complications.

Overall, a myomectomy can provide relief from symptoms caused by fibroids and can improve a patient’s quality of life. The choice between LMy and open conservative myomectomy will depend on individual factors such as the size and location of the fibroids, the patient’s overall health, and the surgeon’s expertise.

What to Ask Your Doctor

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

  1. What are the potential benefits of laparoscopic myomectomy compared to open conservative myomectomy?
  2. What are the potential risks and complications associated with each method?
  3. How experienced are you in performing laparoscopic myomectomy?
  4. What is the expected recovery time for each method?
  5. Will I need to stay in the hospital after the surgery, and if so, for how long?
  6. What can I expect in terms of pain management after the surgery?
  7. Are there any long-term effects or considerations I should be aware of with either method?
  8. Will I still be able to have children after undergoing a myomectomy?
  9. What is the likelihood of the fibroids growing back after the surgery?
  10. Are there any specific precautions or measures I should take before and after the surgery to optimize my outcome?

Reference

Authors: Tanos V, Lee SC, Alexander K, Pavlou A, Balanos I, Sandhu A. Journal: Eur J Obstet Gynecol Reprod Biol. 2023 Aug;287:109-118. doi: 10.1016/j.ejogrb.2023.06.008. Epub 2023 Jun 8. PMID: 37302233