What is a laparoscopic myomectomy?
Myomectomy is the removal of fibroids from the wall of the uterus (womb). This is the preferred treatment for symptomatic fibroids in women who want to keep their uterus. It is an alternative to surgical removal of the whole uterus (hysterectomy).
In Oxford we perform most myomectomies laparoscopically (via keyhole surgery). The advantage of a laparoscopic myomectomy over traditional 'open' surgery, performed through a larger abdominal cut, is that only very small incisions are used. Because the incisions are small, recovery is much quicker, and there is less internal and external scarring. After laparoscopic myomectomy, women usually return to normal activity within a couple of weeks.
Which fibroids can be removed laparoscopically?
Fibroids that are attached to the outside of the uterus by a stalk (pedunculated) are the easiest to remove laparoscopically. Many subserousal fibroids (close to the outer surface) or intramural fibroids (in the wall of the uterus) can also be removed through the laparoscope.
Fibroids that are beneath the inner lining of the womb wall and grow into the endometrial cavity (submucosal) are easier to remove hysteroscopically.
What does the operation involve?
During the operation a telescope (laparoscope) is inserted through a small (1cm) incision, usually in the navel (tummy button). Two or three additional small (0.5-1 cm) incisions are made for keyhole instruments to perform the surgery. The fibroids are detached from the uterus and removed, using a specially devised morcellator. Following removal of the uterine fibroids, the openings in the uterus are stitched closed. The procedure can take 1-2 hours, depending on the number, size, and depth of the fibroids.
What is the recovery like after surgery?
Most women stay in hospital for 24-48 hours after surgery. Usually, on the first morning after the operation the catheter is removed and the patient is able to eat, drink and move around.
Recovery after surgery varies between individuals. Most women will resume driving and work within 2-4 weeks. The body will be using extra energy to build new cells and repair itself and patients may therefore feel tired for 4-6 weeks after surgery.