Laparoscopic Myomectomy

Medically reviewed by Dr Manan Boob, MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

A laparoscopic myomectomy is an operation to remove fibroids from the uterus while leaving the uterus itself in place. Fibroids — myomas, in medical shorthand — are benign muscular growths that develop in or on the wall of the womb. A myomectomy takes out the fibroids. A hysterectomy takes out the whole uterus. That difference matters enormously to a woman who still hopes to carry a pregnancy, and it matters just as much to plenty of women who simply do not want their uterus removed.

The word “laparoscopic” describes how we get there. Instead of one long cut across the lower abdomen, the surgery is done through three or four openings of roughly half a centimetre to one centimetre, using a telescope and slim instruments. On the 3D laparoscopy system in our advanced laparoscopy and hysteroscopy unit, the surgeon sees the plane between fibroid and healthy muscle with genuine depth perception, which makes both the removal and the stitching of the uterine wall afterwards more precise.

Who needs it

Not every fibroid needs an operation. A great many women carry small fibroids their whole lives and never know it. Surgery earns its place when the fibroid is actually causing trouble:

• Heavy or prolonged periods, especially when the bleeding has pushed your haemoglobin down and iron tablets are no longer keeping up.
• Pressure symptoms — a heaviness in the lower abdomen, needing to pass urine far too often, difficulty emptying the bladder, or constipation caused by a fibroid pressing backwards.
• Fertility problems, when a fibroid is bulging into the cavity of the uterus and is a plausible reason for not conceiving or for repeated early miscarriage.
• Pain, particularly the sharp, localised pain of a degenerating fibroid.
• Rapid growth or an uncertain diagnosis on ultrasound or MRI, where we need tissue to be sure.

“My fibroid is 4 cm and I feel absolutely fine. Should I get it removed just in case?” Almost always, no. A small fibroid that is not bleeding, not pressing on anything and not sitting inside the cavity is best left alone and watched with a scan once a year. Surgery is a treatment for symptoms, not for a number on a report.

How it is done

You come to the operating theatre with an empty stomach. After anaesthesia, a urinary catheter is passed so the bladder stays flat and out of the way.

We make a small opening near the navel and gently fill the abdomen with carbon dioxide gas — this lifts the abdominal wall away from the organs and creates room to work. The telescope goes in through that first port, and two or three more ports are placed low down, where the scars will later sit below the bikini line.

Once the uterus and fibroids are inspected, a dilute solution is injected into the uterine muscle around the fibroid to reduce bleeding. The surgeon opens the muscle over the fibroid and shells it out along its natural plane — a fibroid has a definite capsule, and finding that plane is most of the skill of the operation.

The uterine wall is then repaired in layers with absorbable sutures. This part is unglamorous and slow, and it is the part that decides how strong your uterus will be in a future pregnancy. Finally the fibroid is cut into strips inside a protective retrieval bag and removed through one of the small openings, the pelvis is washed out, bleeding points are checked once the gas pressure is lowered, and the tiny cuts are closed.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia — you are fully asleep and remember nothing of it.

A single fibroid usually takes 45 to 90 minutes. Multiple fibroids, or one sitting in an awkward position such as the cervix or the broad ligament, can take two to three hours.

Most women are admitted on the morning of surgery and go home after one to two nights. You will be allowed sips of water within four to six hours, a light meal the same evening, and we will have you walking to the bathroom before you sleep. Early walking is not us being harsh — it is the single best thing you can do to prevent clots and to clear the gas from your abdomen.

Recovery

Day 1. Sore around the cuts, a little bloated, possibly an odd ache in one shoulder from the gas. Regular painkillers, short walks, normal food.

The first week. Tiredness is the main complaint, more than pain. Light bleeding or brown discharge is normal. Keep the dressings dry; you can usually shower from around day three. Most women are off strong painkillers within four or five days.

Weeks 2 to 4. Desk work is realistic from about the second week. Driving once you can brake hard without wincing. No lifting anything heavier than a full water bottle, no gym, no vigorous housework.

By six weeks. Almost everything is back to normal, including exercise and intercourse. Your first period afterwards may be heavier or come slightly late; that settles by the second or third cycle. If you are planning a pregnancy, we will have given you a specific waiting period — usually three to six months — based on how deep into the muscle we had to go.

Why keyhole rather than open surgery

The fibroid removed is the same. What differs is what your body goes through to reach it.

With laparoscopy there is less blood loss, far less post-operative pain, a shorter hospital stay, tiny scars instead of a long one, a much lower rate of wound infection, and a return to normal life in weeks rather than a month or more. Because the tissues are handled gently and stay moist inside a sealed abdomen, there also tends to be less adhesion formation afterwards — which matters if you are hoping to conceive.

Open surgery still has its place, and any surgeon who claims otherwise is selling something. A uterus packed with a dozen fibroids, a very large fibroid in a difficult location, or dense adhesions from previous operations may be safer and quicker through an open incision. Occasionally a laparoscopic operation has to be converted to open midway. That is a judgement call in your favour, not a failure.

Risks and complications

Myomectomy is a safe operation in experienced hands, but it is real surgery and deserves an honest list.

• Bleeding. The uterus has a rich blood supply. A small number of women need a blood transfusion.
• Conversion to open surgery, for the reasons above.
• Infection of a wound or inside the pelvis — uncommon, and usually settles with antibiotics.
• Injury to the bladder, bowel or ureter. Rare, but possible, particularly when previous surgery has stuck things together.
• Adhesions forming later between the uterus and surrounding structures.
• Recurrence. New fibroids can grow over the following years.
• Hysterectomy. Very rarely, if bleeding cannot be controlled, removing the uterus becomes the only safe option. We discuss this possibility with every patient beforehand, and we never treat it as a formality.
• Anaesthetic risks, which our anaesthetist will go through with you separately.
• A scar in the uterine muscle, which may influence how a future delivery is planned.

Alternatives

Watchful waiting. For small, symptom-free fibroids, an annual scan is the whole treatment.

Medical treatment. Tranexamic acid and non-hormonal measures can reduce heavy bleeding. A hormonal intrauterine device works well when the cavity is not distorted. Hormonal injections can shrink fibroids temporarily — useful before surgery, but the fibroids regrow when the drug stops, so this is a bridge and not a cure.

Hysteroscopic myomectomy. If the fibroid is submucous — sitting inside the cavity — it can often be shaved away through the cervix with no abdominal cuts at all. Our simple guide to hysteroscopy explains how that is done.

Uterine artery embolisation, performed by an interventional radiologist, blocks the fibroid’s blood supply. It is not usually the first choice for women who still want to conceive.

Hysterectomy, for women who have completed their family, have severe symptoms, and would rather not risk fibroids returning.

What it costs

Laparoscopic myomectomy at Shubham Hi-Tech Hospital: ₹52,000 – ₹87,000, all-inclusive — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every previous scan, blood report and operation note you have. Old records change plans more often than people expect.
• Tell us about all medicines you take, especially blood thinners, aspirin and diabetes tablets — some must be stopped in advance, and you should never stop them on your own.
• If your haemoglobin is low, we will usually correct it first with iron, and occasionally with a short course of hormonal treatment to stop the bleeding while you build up.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless you are told otherwise.
• Leave jewellery, nail polish and contact lenses at home.
• Arrange for one attendant to stay with you overnight, and someone who can drive you home.
• Plan two clear weeks away from heavy work. Booking surgery for a Friday and expecting to be back at a shop counter on Monday does not go well.

“Do I have to stop trying for a baby before the surgery?” Yes — we will ask you to use contraception in the cycle before your operation, because an early pregnancy nobody knew about changes everything. Once you are healed and we have given you the go-ahead, you can start trying again.

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Fibroids are common, and the decision to operate on them should never feel rushed. If heavy periods, pressure symptoms or difficulty conceiving have brought you to this page, come and talk it through with the gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati — bring your scans, and we will tell you honestly whether surgery is the right answer for you. Call +91-8668954915, get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.