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.

Laparoscopic myomectomy is a surgical procedure used to remove fibroids from the uterus using a laparoscope, a thin, flexible tube with a light and camera on the end. Here is an overview of the procedure:

Anesthesia: The patient will be placed under general anesthesia.

Port placement: Several small incisions will be made in the abdomen to allow access for the laparoscope and other instruments. Typically, three to four ports will be placed.

Inspection of the uterus: The laparoscope will be inserted through one of the incisions to allow the surgeon to view the uterus.

Identification of the fibroids: The surgeon will identify the location, size, and number of fibroids.

Dissection and removal of fibroids: The surgeon will carefully dissect and remove the fibroids from the uterus using specialized instruments.

Repair of the uterus: The surgeon will repair the uterine wall using sutures to minimize bleeding and prevent future scarring.

Closure of incisions: The incisions will be closed with sutures or surgical glue.

Recovery: The patient will be monitored in the recovery room until they wake up from anesthesia, and then will be transferred to a regular hospital room. They may experience mild pain or discomfort, which can be managed with medication.

Laparoscopic myomectomy is generally associated with less postoperative pain, shorter hospital stays, and quicker recovery times compared to traditional open surgery. However, as with any surgical procedure, there are potential risks and complications, such as bleeding, infection, and injury to surrounding organs. It is important to discuss the risks and benefits of laparoscopic myomectomy with your surgeon to determine if it is the best option for you.