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LAPAROSCOPIC MYOMECTOMY

Laparoscopic Myomectomy is the surgical removal of fibroids from the uterus through a small keyhole incisions. Ideally done in unmarried women, married women not completed family, women willing to retain the uterus. In this procedure we remove only the fibroid by making a small incision on the fibroid and remove it by morcellator. Fibroids are benign disease of uterus. Distibution of fibroids – Intramural 75%, Submucous 15%, Subserous, Broad ligament & cervical fibroid < 1%. 

What causes Fibroid?

1) Genetic : Chromosomal abnormalities

2) Age: 20% incidence > 20 yrs 
40% incidence >40 yrs

3) Parity : Common in nulliparous or infertile women

4) Race : Common in African, familial

5) Hormonal: Hyperoestrogenism 

High Risk Factors for Fibroid:

1) Obesity

2) Diabetes

3) Hypertension

4) H/O Polycystic ovaries 

Symptoms of Fibroids:

1) Menstrual Disturbances, the most common symptom of FIBROID. 50% Fibroids are asymptomatic. Women may have a single symptom or present with several complaints depending upon the number, size, and location of tumors. There is progressive menorrhagia (Regularly timed episodes of bleeding that are excessive in amount > 80ml and/or duration of flow > 5days, Polymennorhoea (Frequent & regularly timed episodes of bleeding occurring at intervals of 21 days or less) occurs when cystic ovaries & Pelvic infection coexist. Metrorrhagia (Intermenstrual bleeding ) is common with submucous fibroid.

2) Infertility

3) Pain

4) Abdominal Lump 

Does a patient have FIBROID?

1) The commonest diagnostic test carried out to ascertain fibroid is Ultrasound. Ultrasound shows Fibroid as a well-defined mass.

2) CT/MRI to confirm the diagnosis. It can differentiate from other conditions like adenomyosis, ovarian tumor, ectopic and adnexal mass. It shows the exact location, size and number of fibroids

3) Intravenous pyelogram is required in broad ligament fibroid to check the anatomy and pathology of ureter

4) Blood investigations like hemoglobin to ascertain the degree of anaemia, blood group& Rh typing. 

How is a treatment option selected?

Small and asymptomatic fibroids don’t require removal. They have to be observed every 6 months or medically managed. 

Surgical Rx:

Traditionally all the surgical procedures are done by a bigger incision but we operate it through small key hole incisions of less than 5 mm incision on the abdomen. 

Indications for Surgical Rx:

1) Symptomatic fibroids.

2) Rapidly growing fibroid.

3) Fibroid causing infertility.

4) Fibroid causing pressure symptoms.

What preparations will be needed prior to surgery?

Any investigations or consultations arranged at the preoperative consultation should have been completed, to make sure there are no medical conditions that may cause a problem during the surgery. Patients should not eat or drink anything after midnight on the night before surgery. The bowel preparation medication should be taken as ordered. You should continue your regular medications, unless advised otherwise. Should you develop an illness prior to your surgery, please contact your surgeon immediately. 

What should I do on the day of the procedure?

Unless otherwise specified, you should stop eating and drinking at the following times on the day of the surgery:

1) At midnight for a morning procedure or

2) At 6 am for an afternoon procedure

You should continue all your usual medications, unless otherwise specified. 

What type of anaesthesia will be required when performing hysterectomy?

Patients are put to sleep under general anaesthesia. 

Is there a hospital stay after surgery?

85% of our patients go home the same day as their surgery. 

What should I expect after the procedure?

When you wake from the anaesthetic, you will be in the recovery room. A drip will be maintained for one to two days and the catheter will normally be removed the same day or following day. You should expect a stay of 1 to 2 days in hospital. 

What kind of a recovery can be expected?

Patients should expect to take antibiotics and painkillers for a few days post-operatively. We encourage patients NOT to stay in bed. They should move around the house and resume normal activities as soon as they feel up to it. Some women are well enough to return to work one week after surgery. 

After discharge from hospital, what I should do? 

1) Eat and drink normally

2) Remain mobile

3) Use sanitary pads (not tampons) if required

4) Shower normally 

You should not:

1) Have intercourse for 6 week

2) Undertake any heavy lifting or straining for 6 weeks

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