Dr. R. K. Mishra's Lecture on Laparoscopic Myomectomy at CAMLS, University of South Florida, USA. Fellowship of Minimal Acess Surgery Training course conducted by World Laparoscopy Training Institute, Florida, United States of America.

Laparoscopic Myomectomy and Robotic Myomectomy is a surgical procedure of removing fibroids through small abdominal incisions. Laparoscopic Myomectomy is suggested and advised for those who experience problems due to fibroids. This procedure is usually recommended when the woman wants the fibroids to be removed but wants to preserve the uterus. Fibroids affect daily life as they cause problems such as pelvic pain or pressure, heavy menstrual bleeding, urinary frequency, or incontinence.

Why is Laparoscopic Myomectomy done?
If there are many causes and symptoms that trouble your normal activities such as heavy menstrual bleeding, pelvic pressure or urinary incontinence, then doctors can suggest laparoscopic myomectomy. Some of the reasons to choose myomectomy are –

If planning to bear children.
If the uterine fibroids are interfering with fertility.
If you want to keep the uterus and just want to remove the fibroids.
Types of Myomectomy Techniques
Several techniques are used to remove the fibroid inside the uterus. The choice of the technique can depend on various factors such as the location and size of the fibroids as well as the characteristics of the woman. Various types of Myomectomy include –

Laparoscopic Myomectomy is performed to remove the fibroids in the uterus. This technique is performed using a narrow telescopic like an instrument in order to see inside the abdomen. The procedure involves 4 to 5 incision in the navel and lower abdomen. Fibroids are shell outside the uterus repairing the uterus incision. Recovery time is around 2 to 3 weeks and requires one night of hospitalization. Complications such as bleeding, injury to internal organs, an infection might occur during this procedure which is minimal. Robotic-assisted laparoscopic is also performed for the removal of the fibroids where the robotic system translates the surgeon’s hand movement outside of the patient’s body and precise surgical movement inside the abdomen.
Abdominal Myomectomy, also called laparotomy is performed using a vertical or horizontal incision in the abdominal wall. It allows the surgeon to have direct access to the patient’s uterus and usage of traditional surgical techniques and instruments is done. Anesthesia is given to the patient and a full recovery is expected within 4 to 6 weeks.

Hysteroscopic Myomectomy involves removing a submucosal fibroid from the inside wall of the uterus. A narrow telescope-like instrument is passed through the cervix to visualize the uterus activity in order to allow surgery inside the uterus. This procedure is only performed for smaller fibroid. This procedure is performed under anesthesia in an operating room. Some of the complication faced during this procedure includes fluid overload, bleeding, the formation of scarring inside the uterus, and uterine perforation.