Our Summary

This research paper discusses a common gynecological operation called laparoscopic myomectomy, which is used to remove fibroids in the uterus of premenopausal women. However, since 2014, this surgery has been heavily regulated due to cases where a rare and aggressive type of cancer (uterine leiomyosarcoma or LMS) was unknowingly spread throughout the patient’s pelvis during the procedure.

It’s now thought that LMS may be more common than previously believed, potentially affecting up to 0.13% of women having fibroids removed. The risk of spreading this cancer during surgery is a significant concern for doctors who want to ensure the safety of their patients while also providing minimally invasive treatment options for fibroids.

The paper suggests that doctors could use MRI scans to help identify women who might be at higher risk of having LMS before their surgery. This would allow them to plan for a potentially more invasive surgery (like a hysterectomy) if necessary, or offer the less invasive laparoscopic myomectomy to women at lower risk. The paper also suggests areas for future research to improve the detection and treatment of LMS.

FAQs

  1. What is laparoscopic myomectomy and why is it heavily regulated since 2014?
  2. What is the risk factor of spreading uterine leiomyosarcoma (LMS) during laparoscopic myomectomy?
  3. How can MRI scans help doctors identify women at higher risk of having LMS before undergoing surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the surgery, including the risk of spreading LMS. It’s important for patients to be informed and ask questions about their individual risk factors, so they can make the best decision for their health. Additionally, patients should follow up with their doctor regularly after the surgery to monitor for any signs of complications or recurrence of fibroids.

Suitable For

Patients who are typically recommended for myomectomy are premenopausal women with symptomatic fibroids who wish to preserve their fertility or avoid a hysterectomy. These women may experience symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, and infertility. It is important for these patients to undergo a thorough evaluation by their healthcare provider to determine if myomectomy is the best treatment option for them.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of fibroids such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient consults with a gynecologist who recommends a myomectomy to remove the fibroids.
  3. Patient undergoes pre-operative tests and evaluations to assess their overall health and suitability for surgery.

During myomectomy:

  1. Patient undergoes laparoscopic myomectomy surgery to remove the fibroids.
  2. Surgeon carefully removes the fibroids without damaging the surrounding tissue.
  3. Surgery typically lasts a few hours and is performed under general anesthesia.

After myomectomy:

  1. Patient stays in the hospital for a day or two for monitoring and recovery.
  2. Patient may experience some pain, bloating, and fatigue after surgery.
  3. Patient is advised to rest and avoid strenuous activities for a few weeks.
  4. Follow-up appointments are scheduled to monitor recovery and address any concerns.
  5. Patient may experience relief from symptoms such as heavy bleeding and pelvic pain after the fibroids are removed.

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, including the risk of spreading uterine leiomyosarcoma (LMS)?
  2. How will my doctor determine if I am at a higher risk for LMS before the surgery, and what additional tests or screenings may be recommended?
  3. What are the alternative treatment options for fibroids, and how do they compare to myomectomy in terms of safety and effectiveness?
  4. What is the experience and expertise of the surgical team in performing myomectomy, particularly in regards to minimizing the risk of complications?
  5. How will my recovery process be managed after the surgery, and what are the potential long-term implications of having a myomectomy?
  6. What steps will be taken during the surgery to minimize the risk of spreading any potential cancerous cells?
  7. Are there any specific signs or symptoms to watch out for after the surgery that may indicate a complication, such as infection or LMS spread?
  8. What follow-up care and monitoring will be needed after the surgery to ensure my health and well-being?

Reference

Authors: Hindman N, Kang S, Fournier L, Lakhman Y, Nougaret S, Reinhold C, Sadowski E, Huang JQ, Ascher S. Journal: Radiology. 2023 Feb;306(2):e211658. doi: 10.1148/radiol.211658. Epub 2022 Oct 4. PMID: 36194109