20 CM Large Intramural Fibroid's Laparoscopic Myomectomy
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This video demonstrates Laparoscopic Myomectomy for 20 CM large Intramural Fibroid Uterus performed by Dr. R. K. Mishra at World Laparoscopy Hospital. Uterine leiomyomas (myomas) are benign smooth muscle tumors arising from the myometrium. Most myomas do not cause clinical symptoms and do not require intervention. Nonetheless, the size and location of a myoma are important determinants of its potential to become symptomatic and cause problems ranging from infertility to life-threatening uterine hemorrhage. In the case of very large myomas, the procedure can be recommended as a routine procedure for patients only after its technical feasibility, complication rates, conversion rate, and long- experience as the surgeon. The author has reported a case of a large myoma being removed laparoscopically. If the surgeon’s ability to perform the procedure is unlimited, then, size does not matter for the performance of a myomectomy laparoscopically.
20 CM Large Intramural Fibroid’s Laparoscopic Myomectomy: A Minimally Invasive Breakthrough
Fibroids, also known as uterine myomas, are common noncancerous growths that develop in the uterus. While many fibroids are small and asymptomatic, some can grow significantly large, leading to severe symptoms that require surgical intervention. A 20 cm large intramural fibroid presents a unique challenge, often necessitating open surgery. However, with advancements in laparoscopic techniques, even fibroids of this size can be successfully removed through laparoscopic myomectomy, offering patients a minimally invasive alternative with faster recovery and fewer complications.
Understanding Intramural Fibroids
Intramural fibroids are the most common type of uterine fibroids. They develop within the muscular wall of the uterus and can cause symptoms such as:
- Heavy menstrual bleeding
- Pelvic pain and pressure
- Frequent urination
- Infertility or pregnancy complications
When an intramural fibroid reaches 20 cm in size, it can severely distort the uterus, causing discomfort and affecting a woman's quality of life.
Challenges of a 20 CM Intramural Fibroid
A fibroid of this magnitude presents several challenges:
1. Surgical Difficulty – Removing a large fibroid laparoscopically requires advanced skills due to limited maneuverability.
2. Risk of Excessive Bleeding – Large fibroids have an extensive blood supply, increasing the risk of hemorrhage.
3. Uterine Reconstruction – After removal, the uterus must be carefully reconstructed to maintain its integrity, especially for women desiring future pregnancies.
Laparoscopic Myomectomy: A Minimally Invasive Approach
Traditionally, fibroids of this size were removed through open surgery (laparotomy). However, advancements in laparoscopic techniques now allow skilled surgeons to perform laparoscopic myomectomy, even for large fibroids.
Procedure Steps:
1. Preoperative Preparation
- Hormonal therapy (GnRH agonists) may be used to shrink the fibroid slightly before surgery.
- Preoperative imaging (MRI/ultrasound) is done to assess the fibroid’s location and vascularity.
2. Laparoscopic Surgery
- Small incisions (typically 3-4) are made in the abdomen.
- A laparoscope (a thin tube with a camera) is inserted to provide a magnified view.
- The fibroid is carefully dissected and removed using morcellation, a technique that breaks the fibroid into smaller pieces for easier extraction.
3. Uterine Reconstruction
- The uterus is sutured meticulously to ensure healing and maintain strength.
4. Postoperative Recovery
- Patients typically experience less pain, minimal scarring, and a shorter hospital stay compared to open surgery.
- Recovery time is around 2-4 weeks, significantly faster than traditional surgery.
Benefits of Laparoscopic Myomectomy for Large Fibroids
✅ Minimally Invasive – Smaller incisions lead to less postoperative pain.
✅ Reduced Blood Loss – Advanced surgical techniques help control bleeding.
✅ Faster Recovery – Patients can return to normal activities sooner.
✅ Better Cosmetic Outcome – Minimal scarring compared to open surgery.
Who is a Candidate for Laparoscopic Myomectomy?
Not all patients with large fibroids are candidates for laparoscopy. The feasibility depends on:
- The location and number of fibroids
- The surgeon’s expertise
- The patient’s overall health and surgical history
Conclusion
A 20 cm intramural fibroid is a complex case, but with the latest laparoscopic myomectomy techniques, women now have a safer, less invasive treatment option. Consulting an experienced surgeon is crucial to determine the best approach for optimal outcomes and fertility preservation.
Contact us World Laparoscopy Hospital Cyber City, Gurugram,
NCR Delhi INDIA : +919811416838
World Laparoscopy Training Institute Bld.No: 27, DHCC,
Dubai UAE : +971525857874
World Laparoscopy Training Institute 8320 Inv Dr,
Tallahassee, Florida USA : +1 321 250 7653
3 COMMENTS
Dr. Jesan Harry
#1
Sep 16th, 2022 10:41 am
Some women can have very large fibroids that cause the uterus to be up to 10 times its normal size. This causes what we call “bulk symptoms.” For example, a woman may feel that her uterus is very enlarged, like she's pregnant. She may have related symptoms due to its bulk size, like constipation or increased urination.
Sumanya Singh
#2
Oct 8th, 2022 10:27 am
Uterine fibroids are the most common benign tumors occurring in women in the reproductive age group. The prevalence rates quoted in the literature range from 20 – 50%, based on postmortem studies.[1] The prevalence varies with age, with an increase in the late reproductive period. Current trends suggest that there is a tendency to delay pregnancy to a later age when the incidence of fibroids is more. Indeed, uterine fibroids are detected in a small, but a significant number of infertile women. If a causal relationship between fibroids and infertility can be established, treatment is indicated for enhancing fertility. Laparoscopic myomectomy was described for the first time in 1979, exclusively for subserous fibroids. What a nice video on 20 CM Large Intramural Fibroid's Laparoscopic Myomectomy. Thank you Dr. Mishra for teaching doctors from all over the world.
Dr. Sharad Hemant
#3
Nov 9th, 2023 1:04 pm
Life-changing! The article on Laparoscopic Myomectomy for 20 CM Large Intramural Fibroids is a beacon of hope. The detailed insights, coupled with the success story, provided a reassuring guide for navigating a challenging medical journey. Empowering and informative, it instills confidence in those facing similar situations. Kudos to the author for shedding light on this transformative procedure and offering a ray of hope to those seeking a solution to large intramural fibroids.
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