Laparoscopic myomectomy (removal of uterine fibroids)

Laparoscopic Myomectomy is performed to remove the fibroids in the uterus. This technique is performed using a narrow telescopic instrument in order to see inside the abdomen. The procedure involves 4 to 5 incisions in the navel and lower abdomen. Some fibroids can be removed laparoscopically. Laparoscopic surgical repair of incisions made in the uterus to remove the fibroids heal just as well as similar incisions performed through open laparotomy (large incision) surgery.

Laparoscopic myomectomy is a myomectomy performed with minimally invasive techniques, using a narrow telescope-like instrument (laparoscope) to see inside the abdomen. The abdomen is first inflated with carbon dioxide gas to create space for operating. Four or five small (1/4 – 1/2 inch) incisions are made in the navel and lower abdomen to allow insertion of both the laparoscope and long, narrow instruments through tubes called “ports”. Using the laparoscope to see, the fibroid is shelled out of the uterus, and the uterine incision is repaired. Laparoscopic myomectomy usually requires one night of hospitalization. Recovery time is approximately 2-3 weeks.

Robot-assisted laparoscopic myomectomy is a type of laparoscopic myomectomy performed using robotic surgery techniques and the Da Vinci® Surgical System. As with traditional laparoscopic myomectomy, 4-5 small incisions are made and instruments are placed in the lower abdomen through “ports”. The robotic system translates the surgeon’s hand movements outside the woman’s body into precise surgical movements inside the abdomen. Some feel these instrument capabilities are advantageous for laparoscopic myomectomy and we do sometimes use robotics in this setting. It is important to note, however, that while there is a difference between laparoscopy and laparotomy in terms of patient outcomes, both traditional and robotic laparoscopy offer similar benefits. The experience and skill of the surgeon are much more important than whether the robot is employed as a tool.

As in any surgery, complications from a myomectomy, such as bleeding, infection, or injury to nearby organs, may occur. There is a 1-8% chance of having to convert from a laparoscopic myomectomy to an abdominal myomectomy. During myomectomy, rarely (in less than 1%) an unplanned hysterectomy may be required, for instance, if the uterus bleeds excessively. Recurrent fibroids may follow up to one-third of myomectomies. Pregnancy is not recommended during the first 3-6 months after surgery.

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