Laparoscopic Myomectomy

Indication

   Heavy menstrual flow

   Pelvic or abdominal mass

   Pressure symptoms

The Procedure

   General anaesthesia

   Pneumoperitoneum created by insufflation of carbon dioxide

   Incisions made

   Telescope and instruments passed into abdomen

   Myomectomy done

   Suturing of uterine wound(s)

   Specimen removed

   May need to remove specimen vaginally or by morcellation

   Abdominal wounds closed

   Tissues removed will be sent for pathological examination or disposed of as appropriate unless otherwise specified

   Other associated procedures which may be necessary, such as: blood transfusion, hysterectomy

Photographic and / or video images may be recorded during the operation for education / research / documentation purpose. Please inform the staff if you have any objection.

Similarities with abdominal myomectomy

   Same pathology removed

   Same sequelae

Difference from abdominal myomectomy

   3-4 smaller abdominal wounds

   Less painful

   Faster postoperative recovery

   Earlier discharge, shorter sick leave required

Risk and Complication

   Anaesthetic complications

   Bleeding, may need blood transfusion

   Injury to neighbouring organs especially the bladder, ureters and bowels, may require repair

   May need to perform hysterectomy

   Procedure may not be feasible in case of adenomyosis or fibroid not identifiable because of small size / too deep-seated

   Pelvic infection

   Wound complications including infection and hernia

   Possible adverse effect on future fertility because of adhesion

   Up to 30% of patients may require another surgery for recurrence in 10 years

Specific Complication

   Risk of laparotomy (less than 5% chance)

   Trauma to peritoneal organs and blood vessels

   May have dyspareunia following vaginal wound suturing

   Risk of incisional hernia with larger wounds

   Potential increased risk of uterine rupture during pregnancy because of difficulty of deep suturing

Risk of Not Having the Procedure

   Persistent or worsening of symptoms (heavy menstrual flow, pelvic or abdominal mass pressure symptoms)

   Exact diagnosis cannot be ascertained

After the Procedure

   Can get pregnant but there is a risk of uterine rupture

   Future fertility may be affected

   May need Caesarean section in future pregnancy

Alternative Treatment

   Non-surgical treatment including observation or medical treatment

   Hysterectomy

   Uterine fibroid embolization

   Open / vaginal / hysteroscopic approach

Follow Up

   No special follow up

Remarks

The information contained is very general. The list of complications is not exhaustive and other unforeseen complications may occasionally occur. In special patient groups, the actual risk may be different. For further information, please contact your doctor.