What is laparoscopic surgery for fibroid uterus?

Uterine fibroids are non-cancerous growths that appear either inside, on the outside, or in the wall of the uterus. These commonly appear during childbearing years but can occur at any age. Most uterine fibroids are harmless, and you may not even notice any symptoms.

However, some may cause intense pain, heavy bleeding, anaemia, exert pressure on other organs, and lead to fertility issues. Pain and anti-inflammatory medications, dietary supplements, and birth control pills can relieve the major symptoms, but will not shrink the fibroid.

Myomectomy, or the surgical removal of fibroids from the uterus allows the uterus to remain intact and is the preferred mode of treatment if you plan to become pregnant later. Further, myomectomy can be performed in three ways depending on the size, location and the number of fibroids:

Hysteroscopy (insertion of light viewing instrument through the vagina),
Laparoscopy (involves one or more small incisions into the abdomen) and
Laparotomy (involves a larger incision in the abdomen).

Why do you need the laparoscopy surgery for uterine fibroids?

Surgery is recommended when the fibroid symptoms interfere with your normal activities. Your doctor will recommend myomectomy (removal of fibroids, keeping uterus intact) over hysterectomy (removal of complete uterus) if you plan to have children in future, are not near menopausal age, and/or you want to keep your uterus. Chances of pregnancy after myomectomy may improve, but are not guaranteed.

Your doctor will recommend laparoscopy if there are one or two fibroids of sizes up to 2 inches across, and growing on the outer side of the uterus.

Which specialist should you consult if you have any of the signs and symptoms?

A gynaecologist performs the laparoscopy surgery of uterine fibroids. Discuss all symptoms (heavy bleeding, pain from fibroid pressing other organs) that you have been experiencing, so that the doctor can assess the severity of your condition and the need for surgical removal of fibroid. Laparaoscopy will be chosen as the mode of treatment in the following cases:

Medicines have not relieved anaemia
Pain or pressure continue despite treatment with medicines
The fibroid growth is making changes to the uterine wall. This condition can cause infertility or repeat miscarriages

What are the screening tests and investigations before the surgery?

Your doctor will first conduct a pelvic exam to determine the size of your uterus. S/he may also refer to an ultrasound or similar test to get a visual on the size of fibroid(s) and their exact location. Blood tests will check for anaemia or other related symptoms.

What is the procedure for laparoscopy surgery for uterine fibroids?

Laparoscopic myomectomy is a minimally invasive surgical procedure performed under general anaesthesia. Your surgeon will make a small incision in the lower abdomen (near the belly button) through which s/he will insert a light-viewing instrument (laparoscope). The surgery is performed with instruments that are inserted through other small incisions in the abdomen wall. The fibroid is cut into small pieces and taken out through the incisions in the abdomen, or in rare cases, through an incision in the vagina (colpotomy).

The incisions will be closed with stitches once the surgery is complete; small scars left as a result of it fade away with time. The complete surgery takes about 30 to 90 minutes and may be performed as an outpatient procedure. However, you will be taken to a recovery room for two to four hours immediately after the laparoscopy.

Recovery for laparoscopic myomectomy varies between one to two weeks. This is lesser than the recovery time for other myomectomy procedures (hysteroscopy - two weeks; laparotomy - four to six weeks).

What are the known complications of the surgery?

Like any surgical procedure, there is a small chance for problems to occur in a laparoscopy. These include:

Bleeding from incisions and infection
Damage to a blood vessel or nearby organ. This would require a separate surgery for repair

Call your doctor immediately if you notice any of the following:

Abnormal redness or swelling around the incisions
Bleeding, discharge from stitches or fever
Severe pain in abdomen

What are the dietary and physical activity requirements before and after surgery?

At the time of scheduling your surgery, talk to your doctor about any prescribed or over-the-counter medication that you are taking, and whether you need to change your usual medication routine in the days before surgery. You will need to maintain an empty stomach and bladder for the surgery - follow your doctor's instructions over the number of hours before surgery when you must stop eating or drinking.

Post the surgery, you might feel drowsy for few hours and experience pain and bloating for a few days. Avoid carbonated drinks for one or two days to prevent gas pains and vomiting. Though you can resume your normal activities the next day after surgery, avoid strenuous actions like driving, lifting weights or exercise for a week. Your doctor may advise you to refrain from sexual activity or use of tampons till you recover. Wait for three months before attempting to conceive a baby to allow your uterus to heal.

As a caregiver, how can you support and help the patient cope with the surgery?

If you are assisting someone through a laparoscopic myomectomy, accompany her to the hospital on the day of the surgery. She will require assistance with transportation after the surgery and help with small daily activities like lifting weighty objects.