Laparoscopic Myomectomy: Faster Recovery and Less Pain

By Srisupa Laohaparkorn, M.D.

Obstetrician-Gynecologist,

Specializing in Gynecologic Oncology and Laparoscopic Gynecologic Surgery

     Uterine fibroids (myoma uteri, leiomyoma, leiomyomata, uterine fibroid) are common benign muscle tumors of the uterus, affecting approximately 84% of women aged 30-50 years. They are 2 to 5 times more prevalent in Black and East Asian women compared to Caucasian women. Married women who have not had children also show a higher incidence. Fibroids are most common during reproductive years and typically shrink after menopause.

While most patients are asymptomatic, some may experience heavy menstrual bleeding, pelvic pain, infertility, or pressure-related symptoms such as frequent urination, constipation, hydronephrosis, or bowel obstruction.

Diagnosis of Uterine Fibroids

     Diagnosis involves a pelvic examination and additional imaging studies. These include ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI), and hysterography.

Uterine Fibroid Treatment

Treatment options for uterine fibroids include:

• Observation: Recommended for asymptomatic women, those nearing menopause, or those already in menopause.
• Medication: Used for managing abnormal menstrual bleeding.
• Uterine Artery Embolization (UAE): An alternative for patients with heavy menstrual bleeding or dysmenorrhea due to fibroids who are not candidates for conventional surgery. This method effectively reduces symptoms.
• MRI-guided Focused Ultrasound Surgery (MRgFUS): Uses MRI to precisely locate and deliver focused ultrasound waves to destroy fibroid tissue while preserving surrounding healthy tissue.
• Surgical Treatment: Considered the definitive treatment.

Surgical Options for Uterine Fibroids

1.  Hysterectomy

     This involves the surgical removal of the uterus and is suitable for women who no longer desire future pregnancies or those at risk of uterine or endometrial cancer. Hysterectomy can be performed via open laparotomy, laparoscopic surgery, or transvaginal natural orifice transluminal endoscopic surgery (NOTES), depending on fibroid size and surgeon expertise.

2.  Myomectomy

     This procedure removes only the fibroids while preserving the uterus, making it an option for women who wish to retain their fertility or simply keep their uterus. Myomectomy can be performed via open myomectomy or laparoscopic myomectomy (LM).

Advantages of Laparoscopic Myomectomy

     A meta-analysis comparing laparoscopic myomectomy with open myomectomy showed that LM significantly reduces blood loss, maintains higher postoperative hemoglobin levels, and lessens post-operative pain. However, LM may require a longer operative time.

Read more: Center for Laparoscopic Gynecologic Surgery and Gynecologic Oncology

Laparoscopic surgery is indicated based on the size, location, and number of fibroids, as well as the surgeon's experience and proficiency.