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This video demonstrates Laparoscopic Myomectomy for Posterior Wall Myoma performed by Dr. R K Mishra at World Laparoscopy Hospital. Multiple fibroids, including large fibroids, can be removed during a laparoscopic or robotic myomectomy procedure. Your surgeon will perform a thorough examination and review your MRI with you to plan the laparoscopic myomectomy.

Laparoscopic Myomectomy for Posterior Wall Myoma: A Minimally Invasive Approach

Introduction Laparoscopic myomectomy has revolutionized the surgical management of uterine fibroids, offering women a minimally invasive option with reduced recovery time and improved cosmetic outcomes. Among the different locations of fibroids, posterior wall myomas pose unique surgical challenges due to their proximity to the rectum and sacral nerves. However, with advancements in laparoscopic techniques, surgeons can effectively remove these fibroids while preserving uterine integrity and function.

Understanding Posterior Wall Myoma Posterior wall myomas are fibroids that develop on the back wall of the uterus. Depending on their size and depth, they may be classified as subserosal, intramural, or submucosal. These fibroids can cause symptoms such as pelvic pain, heavy menstrual bleeding, pressure on the rectum leading to constipation, and discomfort during intercourse. In some cases, they may also contribute to infertility and recurrent pregnancy loss.

Indications for Laparoscopic Myomectomy Laparoscopic myomectomy is recommended for posterior wall myomas in the following scenarios:

• Symptomatic fibroids causing severe pain or abnormal bleeding.
• Infertility associated with fibroid-related uterine distortion.
• Large fibroids (>5 cm) that may continue to grow and cause further complications.
• Desire for uterine preservation in women planning future pregnancies.

Surgical Technique

1. Patient Preparation: Preoperative imaging, such as MRI or ultrasound, is used to assess fibroid size and location. Bowel preparation may be recommended to enhance visualization of the surgical field.
2. Anesthesia and Positioning: The procedure is performed under general anesthesia, with the patient placed in the lithotomy position and slight Trendelenburg tilt to optimize exposure.
3. Trocar Placement: Multiple small incisions are made to insert trocars for laparoscopic instruments. A 10-mm port is typically used for the laparoscope, with additional ports for surgical manipulation.
4. Myoma Enucleation: The fibroid is carefully dissected from the surrounding uterine tissue using electrocautery or ultrasonic energy devices, ensuring minimal blood loss.
5. Uterine Repair: The uterine defect is closed in multiple layers using absorbable sutures to maintain structural integrity and reduce the risk of rupture in future pregnancies.
6. Specimen Retrieval: The fibroid is morcellated or removed through a small incision to prevent large uterine defects.
7. Hemostasis and Closure: Hemostatic agents may be applied to prevent excessive bleeding, and ports are closed meticulously to minimize postoperative complications.

Postoperative Care and Recovery Patients undergoing laparoscopic myomectomy typically experience a faster recovery compared to open surgery. Most are discharged within 24-48 hours with instructions for pain management, activity modification, and wound care. Full recovery generally occurs within 2-4 weeks, allowing patients to resume normal activities sooner.

Advantages of Laparoscopic Myomectomy

• Minimally Invasive: Smaller incisions lead to reduced postoperative pain and faster healing.
• Lower Blood Loss: Precision surgical techniques help minimize intraoperative bleeding.
• Shorter Hospital Stay: Most patients can go home within a day or two.
• Preservation of Uterine Function: Ideal for women who wish to conceive in the future.
• Reduced Risk of Adhesions: Compared to open surgery, the risk of intra-abdominal adhesions is lower.

Conclusion
Laparoscopic myomectomy is a safe and effective approach for removing posterior wall myomas while preserving uterine function. With advancements in surgical techniques and instrumentation, this minimally invasive procedure offers excellent outcomes, reduced recovery time, and improved patient satisfaction. Women experiencing symptoms due to posterior wall fibroids should consult with a gynecologic surgeon to determine if laparoscopic myomectomy is the right option for them.

Contact us:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi, INDIA       
Phone/WhatsApp: +919811416838, +919999677788
 
World Laparoscopy Training Institute
Bld. No: 27, DHCC, Dubai, UAE
Phone: +971525857874
 
World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida, USA
Phone: +1 321 250 765