Laparoscopic Management of Uterine Fibroids

What are fibroids and what are the symptoms?

Uterine fibroids, also known as leiomyomas, are non cancerous tumors of the womb or uterus. These tumors start in the myometrium (muscle) of the uterus. Fibroids occur in more than 25% of women in the reproductive age group: 20 – 50 yrs.
The symptoms are usually excessive bleeding and pain during periods, heaviness in lower abdomen, inability to conceive, and if the fibroid is large , then lump in the abdomen and difficulty in passing urine and constipation.

How are fibroids managed?

Medications for uterine fibroids don’t eliminate fibroids, but shrink them in size .Medications called Gn-RH agonists put patients into a temporary menopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. They typically are used for no more than three to six months because of severe side effects. Ulipristal acetate is a steroid that reversibly binds to the progesterone receptor and modulates its activity. It controls fibroid related symptoms by reducing fibroid size.
MRI-guided focused ultrasound is a non-invasive treatment option for reducing fibroid size. It is Performed inside an MRI scanner. The ultrasound transducer focuses sound waves (sonications) into the fibroid to heat and destroy small areas of fibroid tissue. Uterine artery embolization : Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. Complications may occur if the blood supply to your ovaries or other organs is compromised.

What is Minimally Invasive (Laparoscopic) Surgery and how is it different from conventional open surgery?

Laparoscopic fibroids removal is a very patient friendly surgery. Tiny Key-hole incisions are taken on the abdomen through which the Laparoscope and fine long instruments are inserted . The fibroid is separated from the uterus, the capsule is stitched and finally they are sliced into small pieces and removed with the help of an instrument called morcellator through the same key-hole incisions. The benefits are:

Better magnified 3D image by using telescope which increases the precision in surgery.
Minimal postoperative discomfort and pain.
Shorter hospital stay.
Rapid recovery.
Early return to the daily activities.

How does 3-D Laparoscopy help in removing fibroids?

Laparoscopic surgeries are highly skill & technology dependent. One of the largest challenges in laparoscopic surgeries is adaptation to a 2 dimensional (2D) flat view of the surgical field. 3D laparoscopy overcomes this problem by providing excellent depth perception, definition, and resolution. The relationships of structures are more easily defined, and instrument manipulation is easier. The net effect of the display is ‘as though looking at the organ in real life.’ The 3D technology therefore helps make fibroid surgeries simpler and safer with lesser complications.

Do fibroids recur after surgery?

There is a 10 to 15 % chance of recurrence if the woman is young. This is due to an inherent tendency of the uterus to produce fibroids till menopause is reached.

If the uterus needs to be removed, can it be done laparoscopically?

Yes, removal of the uterus i.e. hysterectomy can be done safely laparoscopically. If the woman has multiple large fibroids, has completed her family and is more than 45 years of age, laparoscopic hysterectomy is the method of choice today. Even if the woman has had caesarean sections in the past or any other abdominal surgery previously, she can still undergo hysterectomy laparoscopically. Compared to conventional open surgery there is minimal pain, lesser bleeding and only one day hospital stay with no stiches to be removed.

To summarize, 3D Laparoscopic removal of fibroids is the most patient friendly surgery for women with fibroids and is the best choice. The expertise of the surgeons, safety of anesthesia, teamwork and the quality of equipment remains and determines the hallmarks of good outcome.