Laparoscopic management of uterine fibroids, myomas, which patients are eligible?

Fibroids are benign tumors of the uterus that occur in nearly half of women. Although common, they require treatment only when they cause symptoms in the patient. Generally, symptoms such as heavy vaginal bleeding, prolonged menstruation, pressure-related pain, frequent urination, and constipation are observed. Rarely, malignant uterine tumors, known as sarcomas, may also occur.

In the treatment of fibroids, medication generally does not play a significant role. However, in the initial stages, painkillers, birth control pills, and similar medications may be used. If the patient’s complaints do not subside despite medical treatment, surgery may be considered. In suitable patient groups, fibroids can be removed using minimally invasive laparoscopic surgery. Even if the fibroids are large or multiple, the surgery can still be performed laparoscopically, depending on the surgeon’s expertise.

The most important point to consider in minimally invasive surgery is the removal of the fibroid from the abdomen after it is excised. In previous years, fibroids were fragmented inside the abdomen using devices called morcellators before being removed. However, recent scientific studies have shown that if a fibroid fragmented with a morcellator is later found to be cancerous, the patient’s prognosis significantly worsens. For this reason, in modern laparoscopic fibroid surgeries, the fibroid is placed in a special bag and removed from the abdomen without spreading tissue within the abdominal cavity.

Another important aspect is minimizing blood loss during myomectomy. Techniques such as temporarily clamping the blood vessels supplying the uterus and using special solutions to reduce bleeding have made myomectomy surgeries significantly less bloody. The main advantages of minimally invasive surgery for the patient are quicker discharge from the hospital, less blood loss, reduced pain, and fewer abdominal adhesions.

Experienced surgeons prefer minimally invasive laparoscopic surgery even for fibroids measuring 10-12 cm or in cases with multiple fibroids. Thus, minimally invasive surgery stands out compared to open surgery for suitable patient groups.

Another frequently asked question is the risk of emergency hysterectomy (removal of the uterus) during myomectomy due to bleeding or other complications. When the aforementioned surgical precautions are taken, the likelihood of requiring a hysterectomy during myomectomy is very low. The surgeon’s experience is critical in this regard.

For patients with multiple fibroids in different locations, preoperative imaging is highly important. A good ultrasound performed before surgery can identify the location of almost all fibroids. In unmarried patients, pelvic MRI is also a safe imaging method for determining the exact location of fibroids. Therefore, preoperative evaluation is crucial for such patients.

As mentioned above, laparoscopic minimally invasive surgeries improve patients’ quality of life, result in less blood loss, and speed up the return to normal daily activities.

I wish all my patients a healthy and peaceful life.