Our Summary

This study looked at the surgical outcomes and findings of a procedure called laparoscopic myomectomy, a surgery that removes fibroids (non-cancerous growths) from the uterus, performed at a university teaching hospital between 2004 and 2015. The team analyzed data from 514 women who underwent this procedure, focusing on their medical histories, surgical outcomes and whether there were any complications.

They found that 99.6% of the intended surgeries were completed successfully. Only two cases needed to be converted into open surgery: one because of a suspicion of uterine cancer, and another due to an injury to the bowel during the beginning of the procedure.

On average, the surgeons removed one fibroid per surgery, with the size of the fibroids ranging from 10 to 200 millimeters. The average blood loss was 73 milliliters, and the typical hospital stay was two nights.

In about 9.7% of the cases, there was a breach in the uterine cavity. There were complications in 3.5% of the cases, including excessive blood loss, bowel or bladder injury, and one case of bowel obstruction due to a hernia at the surgical site. Importantly, there were no cases where undiagnosed uterine cancer was found after fibroid removal.

In conclusion, this study suggests that laparoscopic myomectomy is usually successful and has a low rate of major complications. The likelihood of finding hidden uterine cancer is very low.

FAQs

  1. What is the success rate of laparoscopic myomectomy according to the study?
  2. What were the common complications observed after the laparoscopic myomectomy procedure?
  3. How often did surgeons find undiagnosed uterine cancer during laparoscopic myomectomy?

Doctor’s Tip

One helpful tip a doctor might give a patient about myomectomy is to discuss any concerns or questions they have with their healthcare provider before the surgery. It’s important for the patient to understand the procedure, potential risks, and expected outcomes. Additionally, following post-operative instructions for recovery, such as resting, avoiding heavy lifting, and attending follow-up appointments, can help ensure a successful outcome.

Suitable For

Generally, patients who are recommended for myomectomy are those who have symptomatic fibroids, such as heavy menstrual bleeding, pelvic pain, pressure symptoms, and infertility. Patients who desire future fertility and wish to preserve their uterus are also good candidates for myomectomy. Additionally, patients with larger fibroids, multiple fibroids, or fibroids that are causing significant symptoms may benefit from this surgical procedure. However, the decision to undergo myomectomy should be individualized based on each patient’s specific medical history, symptoms, and preferences.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of fibroids such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum.
  2. Patient consults with a gynecologist and undergoes imaging tests (ultrasound, MRI) to diagnose fibroids.
  3. Patient discusses treatment options with their doctor, including myomectomy.
  4. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.

After myomectomy:

  1. Patient undergoes laparoscopic myomectomy procedure to remove fibroids from the uterus.
  2. On average, one fibroid is removed per surgery, with minimal blood loss and a short hospital stay.
  3. In some cases, there may be complications such as breach of the uterine cavity or injury to nearby organs, but these are rare.
  4. Patient recovers from surgery and experiences relief from symptoms of fibroids such as improved menstrual bleeding and pelvic pain.
  5. Patient follows post-operative care instructions and attends follow-up appointments with their doctor to monitor their recovery.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with myomectomy?
  2. How many fibroids do I have and what is their size?
  3. What is the likelihood of needing open surgery during the procedure?
  4. How much blood loss can I expect during the surgery?
  5. How long will my hospital stay be after the procedure?
  6. What is the likelihood of a breach in the uterine cavity during the surgery?
  7. What measures will be taken to minimize the risk of complications during and after the surgery?
  8. How will my recovery process look like and what kind of follow-up care will I need?
  9. Are there any alternative treatments to myomectomy that I should consider?
  10. What is the likelihood of finding undiagnosed uterine cancer during the procedure?

Reference

Authors: Bean EM, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Journal: J Minim Invasive Gynecol. 2017 Mar-Apr;24(3):485-493. doi: 10.1016/j.jmig.2017.01.008. Epub 2017 Jan 16. PMID: 28104498