Myomectomy for Large Fibroids
Patients undergoing laparoscopic or robotically assisted laparoscopic (minimally invasive) surgery recover faster, enjoy superior cosmetic outcome, have less pain and less blood loss as compared to laparotomy (traditional, open) surgery. This is true for myomectomies (removal of fibroids) as well.
Robotically assisted laparoscopic myomectomy (RALM) stands for removal of fibroid/s (leiomyoma/s). RALM is an outpatient surgery (no need for overnight hospital stay).
Normal size uterus weighs one to two ounces. Uterine sizes are defined in comparison to pregnant uterus. Most commonly uteri grow in size due to enlarging fibroids. A “three months (12 weeks) pregnancy” size uterus weighs about one half of a pound. A “four months (16 weeks) pregnancy” size uterus weighs about one and a half pounds. A “five months (20 weeks) pregnancy” size uterus weighs about three pounds. A “six months (24 weeks) pregnancy” size uterus weighs about four to five pounds.
Choosing a Minimally Invasive Gynecologic Surgeon
Performing RALM requires a highly skilled minimally invasive gynecologic surgeon. The larger the uterus, the more challenging is the RALM. A very experienced surgeon can safely remove fibroid/s weighing several pounds still using minimally invasive techniques such as RALM.
Large uteri are usually distorted by large fibroids. This in turn significantly alters uterine anatomy causing difficulty in its proper recognition. It is more difficult to manipulate a large uterus and it is harder to employ the different operative instruments. After removal of fibroid/s the uterine incision/s need to be closed very carefully and precisely in several layers.
Usually, three quarters of an inch (20mm) diameter morcellators are used to remove large fibroids. Again, this requires higher expertize as compared to removal of small uteri using smaller morcellators.
If a surgeon is not experienced enough, then higher blood loss or complications, such as injuries to the uterus or even hysterectomy may occur at a higher rate. Alternatively, a less experienced surgeon may decide to convert to laparotomy in the middle of the operation.
Patients in a need for RALM and are afflicted with large fibroid uteri should choose an experienced surgeon.
The key questions to ask are:
- How large are the fibroids that he/she has removed?
- How many of these fibroids has he/she removed?
- What is his/her complication rate?
- What is his/her conversion rate?
- What is his/her transfusion rate?