Laparoscopic myoma removal
Laparoscopic myoma removal is a minimally invasive surgical procedure in which myomas formed in the uterine wall or on the surface of the uterine wall are removed by making minimal incisions in the abdominal wall.
What is a myoma?
A myoma is a smooth muscle tumour that develops from the proliferation of smooth muscle cells that make up the uterus. It can develop in different parts of the uterus. A myoma is benign lesion, the development of which is associated with hormonal changes, correlating with the amount of oestrogen present in the body. Higher oestrogen levels can promote the growth of myomas, and when the hormone decreases, the size of the nodes can also decrease.
The size of the formed myoma node can be a few millimetres, but it can even grow to the size of a human fist. However, the size of the myoma is not always commensurable to the symptoms caused.
What are the causes of myomas?
The risk of developing myomas is significantly increased if the body’s hormonal balance is upset. If the hormone-producing glands, thyroid, or ovaries are not working properly, they can significantly increase the chance of developing myomas. Oestrogen dominance (upset in the balance between progesterone and oestrogen) can also cause myomas. In addition, it can be traced back to hereditary predisposition, vitamin and mineral deficiencies, stress, or other mental causes.
Based on their location, myomas can be divided into 3 groups, which cause different complaints due to their location, and can also be treated with different procedures because of their location. These are summarized in the table below:
|Intramural myoma||Subserous myoma||Submucosal myoma|
|Location||in the uterine wall||on the uterine surface||in the uterine cavity|
|Complaints||bleeding disorder, prolonged, spasmodic bleeding, chance of pregnancy may be reduced||may affect the surrounding organs (rectum, bladder, pelvis), resulting in urination and defecation complaints, as well as lower back pain||may distort the uterine cavity, chance of pregnancy may be reduced, the myoma can decrease the chance of infertility and miscarriage|
|Treatment method||Laparoscopic myoma removal||Laparoscopic myoma removal||Hystersocopic myoma removal|
When is the intervention necessary?
Myomas often do not cause any symptoms, but in this case, too, a continuous check-up every six months is recommended so that any changes can be treated in time, before more serious complaints appear.
If the size or location of the myoma causes severe complaints or grows too fast, it may be necessary to surgically remove the myoma.
The procedure can be performed by common open abdominal surgery, or by minimally invasive laparoscopic or hysteroscopic surgery. Our specialists prefer minimally invasive techniques.
Myomas located in the uterine cavity are removed by hysteroscopy, and nodes in the uterine wall or on the outer surface of the uterus growing toward the abdominal cavity are removed laparoscopically.
If the surgery is not performed, the risk of further growth of the tumour and the persistence of complaints (pain, infertility, bleeding disorder) can increase.
How is the laparoscopic myoma removal surgery performed?
If laparoscopic myoma removal is recommended, before surgery, the specialist will make an accurate “map” of the location of the nodes in the uterus during an ultrasound examination, which will help determine the exact location of myomas during surgery.
The advantage of the laparoscopic procedure is that the conventional, more straining opening of the abdomen can be avoided, therefore, it reduces the amount of adhesions that may occur later, and speeds up recovery after surgery.
The surgery is performed under anaesthesia. During the operation, the abdominal cavity is filled with carbon dioxide gas, which is required for opening. The doctor makes 4 incisions, 5-10 mm wide in the abdominal wall through which they introduce microsurgical and optical instruments. During removal, the surgeon first opens the uterine wall above the myoma, excises the nodule, and then removes it from the abdominal cavity by dismembering it with a special tool. The doctor sutures the wound of the uterus with stitches, and finally closes the incisions made in the abdominal wall. The duration of surgery depends on the size, number, and location of the nodes.
What are the risks of laparoscopic myoma removal?
Laparoscopy is uncomplicated in the vast majority of patients. According to data from international studies, the incidence of more serious complications does not exceed 1-2%.
Blood transfusion may be required in 5-15% of cases due to blood loss associated with myoma removal. In case of sudden major bleeding or other serious complications (intestinal, vascular, bladder, urinary tract injuries), conventional opening of the abdomen may be necessary.
If the uterine cavity is opened during the removal of the nodes, antibiotic treatment is started during the operation, which should be continued after the operation.
Abdominal formulas can stick to the uterine wound (adhesion), which can cause lower abdominal pain later on.
During postoperative pregnancy, spontaneous rupture of the uterus in the second or third trimester of pregnancy may occur very rarely. Because of the operation on the uterus, a caesarean section is more common during the next childbirth.
Risk factors vary from individual to individual, so be sure to tell your doctor about any previous illness, surgery, possible surgical complications, and sensitivity to medications to minimize the risk of laparoscopic myoma removal surgery.
How long does full recovery take?
The recommended hospital stay after laparoscopic myoma removal surgery is 2-3 days on average, the length of which is determined by your doctor. Suture collection is done 1 week after the procedure. The average length of recovery is 2-4 weeks, during which a health conscious lifestyle is recommended.