Laparoscopic Myomectomy: Surgery to Remove Uterine Fibroids

Laparoscopy is an innovative surgical procedure used both for diagnosis and treatment of problems in the abdominal cavity. During laparoscopy, an optical system that transmits images to a monitor is inserted through specially created access points in the abdominal wall. Additional instruments can also be introduced through small incisions, allowing surgeons to perform various procedures.

Laparoscopic myomectomy is an advanced surgical procedure for removing fibroids while preserving the uterus through small incisions in the abdominal wall. This procedure is especially suitable for women who are planning pregnancy or wish to preserve their menstrual cycle. The exact steps of laparoscopic myomectomy depend on the characteristics of the fibroid, such as its size, location, and the number of nodules in the uterus.

ATTENTION!
The information on this page contains descriptions and footage of surgical procedures that are not recommended for sensitive or impressionable individuals. The photos and videos below are not intended for persons under 18 years of age.

Differences from Traditional Surgery

Laparoscopic surgery for removing uterine fibroids differs from traditional surgery in several key aspects.

Instead of making a large incision across the abdomen and directly viewing the abdominal cavity, the surgeon performs the operation while observing the process on a large video monitor. This requires a high level of visual and motor coordination, as well as a good knowledge of pelvic anatomy.
Laparoscopic myomectomy is a safe and effective procedure when performed by an experienced specialist with appropriate training. It is technically complex and requires a high level of skill and experience compared to abdominal surgery.

Step-by-Step Removal of Uterine Fibroids

The process of conservative removal of uterine fibroids includes four important stages:

Dissection and removal of fibroid nodules from the organ tissue.
Careful restoration of myometrial defects, including suturing the wound on the uterine surface.
Gentle extraction of fibroid nodules from the uterus.
Ensuring hemostasis and sanitation of the abdominal cavity.

Indications for Conservative Myomectomy

Indications for conservative myomectomy may include the following conditions:

Uterine fibroids reaching a size equivalent to 12 weeks of pregnancy or more in women of reproductive age.
Presence of at least one fibroid nodule larger than 3.5 cm in women planning pregnancy.
Fibroids of any size in cases of miscarriage or infertility, provided other causes have been excluded.
Fibroids causing bleeding due to deformation of the uterine cavity and impaired contractility, which may lead to anemia.
Rapid and significant growth of fibroids, increasing by more than 4 weeks of pregnancy size per year.
Pelvic pain syndrome caused by impaired blood circulation in fibroid nodules.
Dysfunction of adjacent organs such as the bladder and intestines due to tumor pressure.

Consultation with a specialist and thorough examination help determine indications and choose the optimal treatment method.

Contraindications for Laparoscopic Removal of Uterine Fibroids

Contraindications may include the following conditions:

Decompensated cardiovascular or respiratory diseases, diabetes, liver failure, blood disorders, and other serious conditions requiring specialist consultation.
Malignant diseases of the endometrium or cervix. Biopsy is the most informative diagnostic method.
Severe adhesions after previous surgeries and obesity grade II–III are relative contraindications and require careful risk assessment.
Multiple fibroids require special attention due to higher recurrence rates (30% or more), compared to single fibroids (10–20%).

The decision to perform laparoscopic myomectomy requires an individual approach.

Recovery After Surgery

After surgery, the postoperative period includes the following features:

Four small incisions (5–10 mm) remain on the abdomen.
Patients begin to get up and consume liquids on the first day after surgery.
Discharge usually occurs on days 4–6 after stabilization.
Scars on the uterus require special attention during future pregnancies and childbirth.

Video – Laparoscopic Removal of Uterine Fibroids

Many patients wonder how a large fibroid (for example 9 cm) can be removed through small incisions. In this video, I show a fragment of the operation: we remove it using a special instrument called a morcellator, which fragments the fibroid for safe extraction.

Laparoscopic myomectomy