Do you know about laparoscopic myomectomy?

Author: Peng Xiangju

Unit: Zengcheng Branch of Women and Children's Medical Center Affiliated to Guangzhou Medical University

Uterine fibroids, as one of the most common benign tumors of the female reproductive system, often cause many inconveniences in women's lives. With the continuous advancement of medical technology, laparoscopic myomectomy has gradually become the preferred method for treating uterine fibroids due to its unique advantages [1]. This article aims to popularize the relevant knowledge of laparoscopic myomectomy to the general readers and help everyone better understand this operation.

1. Basic knowledge of uterine fibroids

Uterine fibroids, also known as uterine leiomyoma, are the most common benign tumors in the female reproductive organs. Uterine fibroids are mainly formed by the proliferation of uterine smooth muscle cells and can occur in multiple parts of the uterus, such as the uterine body and cervix, but most commonly occur in the uterine body.

The picture comes from the Internet

The symptoms of uterine fibroids vary from person to person. Some patients may have no obvious symptoms and are only discovered accidentally during a physical examination. Patients with symptoms often show increased uterine bleeding and prolonged menstruation, abdominal masses and compression symptoms, pain, and increased leucorrhea. These symptoms not only affect women's quality of life, but may also affect their reproductive function.

2. Principles and advantages of laparoscopic myomectomy

Laparoscopic myomectomy is a minimally invasive surgery that involves making a small skin hole above the patient's navel, inserting a pneumoperitoneum needle, and creating pneumoperitoneum to expand the abdominal cavity and provide sufficient operating space for the surgery. Next, several tiny incisions are made at appropriate locations on the patient's abdomen, and a laparoscope and related surgical instruments are inserted to remove the uterine fibroids under direct vision. Finally, the doctor will check that there is no active bleeding, suture the wound, and close the pneumoperitoneum and incision.

The picture comes from the Internet

Compared with traditional open surgery, laparoscopic myomectomy has the following obvious advantages:

(I) Less trauma: Since the surgical incision is small, the damage to the surrounding tissues is also small, which is conducive to postoperative recovery. Compared with traditional open surgery, laparoscopic surgery significantly reduces the trauma and reduces the pain of patients.

(ii) Quick recovery: The patient will experience less pain after surgery and the recovery time will be significantly shortened. Usually, the patient can be discharged from the hospital a few days after surgery and quickly resume normal life and work.

(III) Fewer complications: Laparoscopic surgery is precise and has little impact on other organs in the abdominal cavity, so the incidence of postoperative complications is low. In addition, laparoscopic surgery can also effectively prevent complications such as abdominal adhesions.

(iv) Good aesthetics: Since the surgical incision is small and concealed, it has little impact on the appearance of the abdomen, which meets the modern women’s pursuit of beauty.

(V) High safety: Laparoscopic surgery is performed under direct vision through a microscope, with the surgical field clearly exposed. Doctors can more accurately diagnose the condition and perform the surgery, thus improving the safety and accuracy of the surgery [2].

3. Indications and contraindications of laparoscopic myomectomy

1. Indications

Laparoscopic myomectomy is a minimally invasive surgical method for uterine fibroids. Its indications mainly include the following situations:

1. Symptoms caused by fibroids: When uterine fibroids cause excessive menstrual flow, secondary anemia, or severe abdominal pain, dyspareunia, chronic abdominal pain, and acute abdominal pain caused by torsion of pedunculated fibroids, surgical treatment should be considered.

2. Symptoms of fibroid compression: If the fibroid is large and compresses organs such as the bladder and rectum, causing symptoms such as frequent urination, urgency, and constipation, surgical treatment should also be considered.

3. Infertility or recurrent miscarriage: If fibroids affect reproductive function, leading to infertility or recurrent miscarriage, surgery can also be considered to remove the fibroids and improve fertility.

4. Fibroid degeneration or suspected sarcoma transformation: When fibroids degenerate or are suspected of sarcoma transformation, timely surgical treatment is required to avoid worsening of the disease.

5. For some intramural fibroids, subserosal fibroids, broad ligament fibroids and cervical fibroids, if the maximum diameter of the fibroid is less than or equal to 8-10cm and the number of fibroids is less than or equal to 4, laparoscopic myomectomy can also be considered.

(II) Contraindications

Although laparoscopic myomectomy has many advantages, not all patients with uterine fibroids are suitable for this surgery. The following are some common contraindications:

1. Poor general condition: If the patient's general condition is poor and cannot tolerate surgery, laparoscopic myomectomy is not suitable.

2. Severe bleeding diseases: If the patient suffers from a severe bleeding disease, such as hemophilia, uncontrollable bleeding may occur during surgery, so surgery is not recommended.

3. Severe pelvic adhesions: If the patient has severe pelvic adhesions, laparoscopic surgery will be difficult to perform and the fibroids may not be completely removed, or other organs may be damaged during the operation. Therefore, surgery is not recommended.

4. Concomitant with other malignant tumors: If the patient also suffers from other malignant tumors, such as ovarian cancer, cervical cancer, etc., these malignant tumors should be treated first, so laparoscopic myomectomy is not appropriate [3].

5. For intramural uterine fibroids with a diameter of less than 3 cm or in special tumor growth locations, the suitability of laparoscopic myomectomy should also be carefully considered.

The picture comes from the Internet

4. Postoperative care and precautions for laparoscopic myomectomy

1. Postoperative Care

1. Vital signs monitoring: After surgery, the patient's vital signs need to be closely monitored, including body temperature, pulse, respiration, and blood pressure, to ensure that the patient's vital signs are stable.

2. Incision care: Keep the surgical incision clean and dry to avoid infection. If the incision is bleeding, exuding, or red and swollen, notify the doctor in time.

3. Pain management: Patients may feel pain after surgery. Doctors will give appropriate analgesics to relieve the patient's pain according to the degree of pain.

4. Dietary guidance: In the early postoperative period, the patient may need to fast for a period of time. After the gastrointestinal function is restored, the patient can gradually start eating. The diet should be light and easy to digest, and spicy and irritating foods should be avoided.

5. Activity guidance: Encourage patients to get out of bed and move around early to promote gastrointestinal motility and exhaust, and prevent intestinal adhesion. However, the amount of activity should not be too large, and strenuous exercise and lifting heavy objects should be avoided.

(II) Notes

1. Regular follow-up: Regular follow-up is required after surgery to understand whether the fibroids have recurred or remained, as well as the recovery of the uterus. The doctor will develop a follow-up plan based on the patient's specific situation.

2. Maintain a healthy lifestyle: After surgery, patients should maintain a good lifestyle, including a reasonable diet, moderate exercise, adequate sleep, etc., to promote physical recovery and health.

3. Psychological adjustment: Surgery may cause patients to have negative emotions such as anxiety and depression. Family members and medical staff should give patients enough care and support to help them face the surgery and recovery process positively.

In short. As a minimally invasive surgery, laparoscopic myomectomy has gradually become the preferred method for treating uterine fibroids. Through the popular science introduction of this article, I believe that everyone has a deeper understanding of laparoscopic myomectomy. Here, we also call on medical workers to continue to explore and innovate surgical techniques to bring good news to more patients.

References

[1] Zhang Xingjuan. Study on the application effect of early warning nursing based on risk assessment in the operating room nursing of patients undergoing laparoscopic myomectomy[J]. Electronic Journal of Practical Gynecological Endocrinology, 2023, 10(36): 132-134.

[2] Shi Yangyang. Nursing experience of patients undergoing laparoscopic myomectomy[J]. Everyone's Health, 2023, (24): 122.

[3] Xiu Limeng, Wang Peng. Effect of laparoscopic myomectomy on ovarian function in patients[J]. Chinese Journal of Maternal and Child Health, 2024, 39(07): 1355-1358.