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3rd January 2018

Laparoscopic Surgery for the Removal of Fibroids

Fibroids are benign growths within the uterine muscle, and can be very debilitating. Often by the time we see patients they are very symptomatic with heavy periods causing anaemia or a large lump pressing on the bladder and other organs. Whilst benign, fibroids over 6cm can be removed in order to allow the patient to return to and enjoy a normal life.

However, for many patients the thought of open surgery is not very appealing, the large scar and a long recovery time can be off putting. In recent years, laparoscopic or keyhole surgery has provided a viable, and often preferable, option for many fibroid removal procedures.

Laparoscopic surgery is a procedure where 3 or 4 small incisions (5-15mm) are made on the abdomen. A device called a laparoscope (a narrow tube with a fitted camera) is inserted through an incision, to allow the surgeon to see the fibroids. A special device (morcellator) is used to cut the fibroid into smaller pieces which are extracted through the incision. Whilst it is a more complicated procedure, requiring specialist surgical skills and longer time in theatre, it also offers many benefits.

What are the benefits of laparoscopic removal of fibroids? 

  • Shorter recovery time: The main benefit of laparoscopic surgery is tiny incisions, this means a much shorter recovery time; often patients will stay in hospital for 24 hours and are up and about within a few hours of their operation and can return to work within 2-4 weeks. In comparison, with an open procedure (open myomectomy) patients can expect stay in hospital for 3-5 days after surgery, and return to work within 6 weeks.
  • Smaller scar: The reduced incision is cosmetically appealing and for patients who prefer to wear bikinis or who don’t want a “long” or “big” scar, laparoscopic surgery is a very attractive option.
  • Lower risk of infection: Medically speaking, where possible, laparoscopic surgery is preferred as there is less risk of wound infection and also pelvic infection as tissue handling is minimal and is carried out by single use sterile instruments.
  • Less risk of thromboembolism (blood clot to the legs or lung) as women tend to be mobile sooner which helps with better circulation.
  • Better preservation of fertility as there is less risk of adhesions and blockage of tubes.

When is a laparoscopic removal not possible?

There are instances where laparoscopic removal of fibroids simply isn’t possible. The size and location of fibroids will play a role in determining the procedure type, generally speaking fibroids smaller than 12cm can be removed laparoscopically but greater than this will depend on individual circumstances.

Age may also influence the possibility of having a laparoscopic removal. Patients over 50 years of age aren’t suitable for laparoscopic removal of fibroids due to higher risk of cancerous change within the fibroids.

Finding the right surgeon 

Laparoscopic surgical skills are specialist skills meaning that not every surgeon is able remove fibroids this way, so it may take more time to find an appropriate surgeon.

Finding the right surgeon is also important as trust plays an enormous role; in some circumstances the surgeon may not be able to decide whether a laparoscopic procedure is possible until the day of the surgery itself.  They may begin the surgery laparoscopically and move to an open procedure if it is required to complete the procedure successfully.

This would be discussed at length in the consultation before the procedure is booked so that the patient is comfortable and has had time to understand the situation and discuss the decisions she wishes the surgeon to make on the day.

Every year at London Gynaecology, we complete over 50 fibroid removal operations and over 90% are carried out by key-hole surgery.

Please visit our specialist website, London Fibroids, for more information, or call us on 0207 10 11 700.

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