Name of the Procedure:

Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g

Summary

This minimally invasive surgical procedure involves using specialized instruments and a camera to remove five or more fibroids (noncancerous tumors) located within the muscular wall of the uterus. Alternatively, this procedure also applies to cases where the total weight of the fibroids removed is greater than 250 grams.

Purpose

The primary purpose of this procedure is to alleviate symptoms caused by large or numerous fibroids, such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel. The goal is to improve the patient's quality of life by removing the problematic fibroids while preserving the uterus.

Indications

• Heavy or prolonged menstrual bleeding
• Pelvic pain or pressure
• Frequent urination or difficulty emptying the bladder
• Bowel complications such as constipation
• Infertility or recurrent pregnancy loss related to fibroids
• Rapidly growing fibroids

Preparation

• Patients are generally instructed to fast for at least 8 hours before the surgery.
• Certain medications may need to be adjusted or paused.
• Preoperative assessments often include blood tests, imaging studies (e.g., ultrasound, MRI), and a thorough medical evaluation.

Procedure Description

1. General anesthesia is administered to ensure the patient is asleep and pain-free.
2. A small incision is made near the navel, and a laparoscope (a thin tube with a camera) is inserted to visualize the uterine fibroids.
3. Additional small incisions are made to insert surgical instruments.
4. The fibroids are excised and removed through the incisions. If the fibroids are large, they may be broken down into smaller pieces for removal.
5. After ensuring all fibroids are removed and bleeding is controlled, the instruments are withdrawn, and the incisions are closed with sutures.

Duration

The procedure typically takes between 2 to 4 hours, depending on the number and size of the fibroids.

Setting

This surgery is usually performed in a hospital's surgical suite or an outpatient surgical center equipped with the necessary technology.

Personnel

• A specialized gynecologic surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs (e.g., bladder, bowel)
• Anesthesia-related complications
• Scar tissue formation (adhesions)
• Recurrence of fibroids

Benefits

• Alleviation of symptoms such as pain, heavy bleeding, and pressure
• Preservation of the uterus, allowing for future fertility
• Minimally invasive approach often results in quicker recovery and less postoperative pain

Recovery

• Patients typically can go home the same day or after an overnight stay.
• Postoperative instructions may include rest, avoiding heavy lifting, and pain management.
• Full recovery generally takes 2 to 4 weeks, with follow-up appointments to monitor healing.

Alternatives

• Medications (e.g., hormonal treatments) to manage symptoms
• Uterine artery embolization to shrink fibroids
• Traditional open myomectomy for larger or more complex cases
• Hysterectomy (removal of the uterus) for definitive treatment

Pros and cons:

• Medications may provide temporary relief but do not remove fibroids.
• Uterine artery embolization is less invasive but may not be suitable for women desiring future pregnancies.
• Open myomectomy involves a larger incision and longer recovery.
• Hysterectomy eliminates fibroids entirely but results in loss of fertility.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel any pain. Post-procedure, patients may experience some discomfort and mild pain, which can be managed with prescribed medication. Patients are encouraged to follow their doctor's instructions closely to ensure a smooth and speedy recovery.