First it is important to understand what Myomectomy means. Myomectomy carries two terms in it, in other words myomectomy can be divided into two, which is, Myoma which means fibroids and ectomy which means removal. Therefore laparoscopic myomectomy is the minima invasive surgical procedure used in the removal of fibroids.
 

Many women who have symptomatic fibroids prefer laparoscopic myomectomy because of its myriad advantages. Laparoscopic myomectomy is the best procedure that is used to manage large intramural fibroids in women who happen to have them. However, this requires very qualified laparoscopic surgeon because the meticulous repair of the uterus cam be a difficult task to perform. Actually this surgical requires surgeon-specific limitations therefore it cannot be done by just any laparoscopic surgeon.
 

Laparoscopic myomectomy is performed as out-patient surgery under the general anaesthesia. During this procedure small incisions are made below the pubic hairline and a very thin instruments that are connected to a camera are then introduced through the incisions. Here the surgeon observes the display on the high definition monitor unlike in the open procedure where he views the internal organs directly.
 

The surgeon controls the instruments that are through the incisions in order to detach the fibroids from the uterus. Generally the incisions are very small and when the large fibroids are detached from the uterine wall, they need to be removed from the abdomen. Therefore they need to be cut into small pieces by use of an instrument known as morcellator while still inside the abdomen so that they can be removed through the small incisions. After the fibroids have successfully been removed from the abdomen, the openings made in the uterus are sutured closed using special instruments that are called suture holders and the grasp instruments.
 

However to effectively perform this procedure it requires maximum hand-eye coordination. The surgeon should also be equipped with vast knowledge about the pelvic anatomy so that the whole process can be a success. Laparoscopic myomectomy is an effective surgical process that is chosen by women who have troublesome fibroids that maybe interfering with their fertility and yet they have not reached menopause.
 

Laparoscopic myomectomy has several limitations which depend on several factors. Here are some of the known factors.

• Size of the fibroids- there are different sizes of the fibroids, smaller fibroids are easier to remove than the larger fibroids. However, there are excellent laparoscopic surgeons who are capable of removing as large as 15cm fibroids. The majority of the surgeons are very effective at removing fibroids that fall below 8 cm.

• Position of the fibroids- fibroids that are so deep into the uterine muscle wall are so difficult to remove. Those are almost outside of the uterine muscle wall and are on a stalk are deemed as very easy to remove. Also, in the position factor the closeness to the fallopian tube and the blood vessels should be well considered in order to avoid damage that can lead to complications.

• Number of the fibroids- many fibroids are very difficult to remove since they would probably require separate incisions. These incisions need to be sutured separately too and this would take a lot of time and require very high skills in order to be successful.

• Fertility- laparoscopic myomectomy can be done to get rid of the fibroids that are hindering fertility of a woman. If fertility is desired in future laparoscopic myomectomy should not be done more often in order to ensure the strength of the uterine wall. If fertility is not desired in future, this procedure can be done any time depending on the number and size of the fibroids.

Advantages of Laparoscopic Myomectomy

Laparoscopic myomectomy is preferred by many women because of its many advantages. These advantages are similar to those of the general a laparoscopic surgery since laparoscopy myomectomy is a type of laparoscopic surgery. 

Let’s look at some of the advantages.

• Faster recovery- laparoscopic myomectomy involves small incisions that are made in the pubic hair line. Since they are just small incisions healing usually takes a very short time. As aforementioned this procedure is actually done as an out-patient surgery and one can get back to her normal life without any complications.

• Shorter hospital stay- laparoscopic myomectomy has greatly reduced the stay at the hospital due to faster healing process that is associated with it.

• Reduced blood loss- since only small incisions are made, there is low blood loss and patients don not require blood transfusion. This would not be the case if it was an open procedure where the surgeon has to make large openings in order to locate and remove the fibroids.

• Higher rate of pregnancy- women with troublesome fibroids are usually rendered infertile and thus cannot conceive. When laparoscopic myomectomy is successfully performed on such women with a desire for future fertility, the pregnancy rate is usually increased. This procedure allows the repair of the uterine muscle wall in order to ensure a strong uterine muscle wall closure. Women who desire future fertility should avoid having many laparoscopic myomectomy procedures performed on them in order to have a strong uterus.

• Low scarring- small incisions can be sutured closed and the scars are significantly small. 

• Less pain- laparoscopic myomectomy avoids the use of abdominal myomectomy which is associated with a lot pain and longer recovery time.

• Post-operative complications significantly fewer.

• Applicable to patients with prior surgeries, patient with several fibroids and also the obese patients.

Laparoscopic myomectomy has many advantages, nevertheless the disadvantages associated with procedure should also be considered. Here are some of its disadvantages.
 

• Highly experienced personnel- this procedure requires a high degree of skills to perform and in the suturing procedure. It has specific skills limitations so that the operations can be successful.

• Limited flexibility of the removal of the fibroids- the location of the fibroids in the uterus determines the ease of removal of fibroids. If the fibroids are deep inside the uterine muscle wall the flexibility of the technique could be very limited.

• Longer operating time- laparoscopic myomectomy is usually a difficult procedure to perform. Therefore it frequently takes longer operating time to locate the edges of the uterus and to successfully remove the fibroids.

Risks of laparoscopic myomectomy 

Laparoscopic myomectomy has several risk or complications. However, these complications are not many and they rarely occur if the procedure is performed properly. The probability if these risks occurring increases with the number, size and location of the fibroids. As early mentioned the removal of fibroids from the uterine muscle wall can be rendered difficult if the fibroids are very large, many, and also if they are deeply located on the uterine muscle wall.

• Uterine rupture- this risk is usually associated with laparoscopic myomectomy during pregnancy. If the risk of uterine rupture is very high it could certainly lead to a high rate of caesarean section being performed on women who previously underwent laparoscopic myomectomy.

• Recurrence- the size and location of the fibroids determine the recurrence of the fibroids. The tiny fibroids that are located deep inside the uterine wall are difficult to detect and remove. Therefore, the probability of them being missed is high hence high rates of recurrence.

• Adhesions- this increases with the location of the fibroids that require posterior incisions.

• Other complications could occur as the procedure is being performed and they include bowel or ureteral injury and also the unplanned conversion to hysterectomy.
 

It is important to note that laparoscopic myomectomy complications have significantly decreased with the new and innovative techniques being brought up. The instruments are rapidly being improved and this is greatly making laparoscopic myomectomy a safe technique for women.
 

Conclusion
 

Laparoscopic myomectomy can be performed on all women, it is not actually associated with any age impacts. However, laparoscopic myomectomy is technically a very difficult procedure to perform but when this procedure is performed by a very qualified personnel it becomes a success. To increase its effectiveness, this calls for quality and regular training of surgeons on the new improved techniques and instruments. 
 

Laparoscopic myomectomy is advantageous over open myomectomy procedure because it has greatly reduced blood loss, shorter recovery period, reduced pain and morbidity. If this procedure is performed by highly skilled personnel, the rate of complications is significantly reduced therefore making it a very effective and safe procedure for all women.
 

Advancements in new technology have a significant improvement in this new technique. With time this procedure will become easier to perform. The location, size as well as the number of the fibroids or myomas will not be an issue. This will depend on the instruments that are used in this procedure. Effectiveness of the procedure is what every surgeon is looking for and when performed on women who desire fertility in future, it has really improved the rate of pregnancies.