Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas
CPT4 code
Name of the Procedure:
Laparoscopy, Surgical, Myomectomy, Excision; 1 to 4 Intramural Myomas with Total Weight of 250 g or Less and/or Removal of Surface Myomas.
Summary
Laparoscopic myomectomy is a minimally invasive surgical procedure where small incisions and specialized tools are used to remove one to four myomas (fibroids) from the uterus. The total weight of the removed fibroids is 250 grams or less. This procedure can also include the removal of fibroids present on the surface of the uterus.
Purpose
This procedure addresses the presence of uterine fibroids, which are non-cancerous growths that can cause symptoms like heavy menstrual bleeding, pelvic pain, and infertility. The goal is to alleviate these symptoms, improve quality of life, and preserve the uterus for future pregnancies.
Indications
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Difficulty with urination or bowel movements due to fibroid pressure
- Infertility or recurrent pregnancy loss associated with fibroids
- Rapid growth of fibroids
Preparation
- Fasting for at least 8 hours before the procedure.
- Adjustments or temporary discontinuation of certain medications (as advised by the doctor).
- Preoperative diagnostic tests such as ultrasound, MRI, or blood tests.
- A thorough medical evaluation and consultation to discuss any existing medical conditions or allergies.
Procedure Description
- The patient is given general anesthesia to ensure they are asleep and pain-free during the surgery.
- Small incisions are made in the abdomen, usually near the navel.
- A laparoscope (a thin tube with a camera) is inserted through one of the incisions to provide a visual guide for the surgeon.
- Additional small incisions are made for inserting specialized surgical instruments.
- The surgeon locates and carefully removes the fibroids from the uterine wall.
- Any bleeding is controlled, and the uterine tissue is sutured.
- The instruments are withdrawn, and the small incisions are closed with stitches.
Duration
The procedure typically takes between 2 to 3 hours, depending on the number and size of fibroids.
Setting
The procedure is performed in a hospital or an outpatient surgical center equipped for laparoscopic surgeries.
Personnel
- Surgeon specialized in gynecology or minimally invasive surgery
- Surgical nurses
- Anesthesiologist
- Surgical technologists
Risks and Complications
- Bleeding
- Infection
- Injury to surrounding organs (bladder, intestines)
- Adhesion formation (scar tissue)
- Reoccurrence of fibroids
- Possible need for a more extensive surgery if complications arise
Benefits
- Relief from symptoms like heavy bleeding, pelvic pain, and pressure.
- Preservation of the uterus, allowing for the possibility of future pregnancies.
- Shorter recovery time and less postoperative pain compared to open surgery.
- Minimally invasive with smaller scars.
Recovery
- Post-procedure care includes monitoring in a recovery room until anesthesia wears off.
- Pain management through prescribed pain relievers.
- Instructions for wound care and activity restrictions for a few weeks.
- Avoiding heavy lifting and strenuous activities.
- Follow-up appointments to monitor healing and discuss any concerns.
- Most patients can return to normal activities in about 2 to 4 weeks.
Alternatives
- Medications to manage symptoms, such as hormonal treatments.
- Uterine artery embolization (UAE) to shrink fibroids.
- MRI-guided focused ultrasound surgery.
- Hysterectomy (complete removal of the uterus) as a definitive solution for those who do not wish to preserve fertility.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, some discomfort and soreness at the incision sites are common. Pain relief medications will be provided to manage this. Patients may experience bloating and mild cramping as they recover. Follow-up care includes guidance on physical activity and monitoring for any signs of complications.