Laparoscopic myomectomy is a surgical procedure to remove fibroids through small incisions in the abdominal cavity. Laparoscopic myomectomy is recommended for patients who have problems due to fibroids, especially to protect the uterus. This procedure is usually recommended when patients want to have their fibroids removed, but also to preserve the uterus. Uterine fibroids affect daily life by causing pain or pressure in the abdomen, excessive menstrual bleeding, frequent urination or incontinence.

Types of Myomectomy Techniques

Various techniques are used to remove fibroids in the uterus. The choice of technique may depend on several factors, such as the location and size of the fibroids and the characteristics of the patient. The different types of myomectomy are:

• Laparoscopic myomectomy is performed to remove fibroids in the uterus. In this technique, a laparoscope is used as an instrument to see inside the abdomen. The procedure requires 4 to 5 incisions in the belly and lower abdomen. Recovery time is about 2 to 3 weeks and requires one to two nights in the hospital. Complications such as bleeding, injury to internal organs and infection can occur during this minimal procedure.
• Abdominal myomectomy, also called laparotomy, is performed through a vertical or horizontal incision in the abdominal wall. It allows the surgeon direct access to the patient's uterus and the use of traditional surgical techniques and instruments. The patient receives anesthesia and is expected to fully recover within 4-6 weeks.
• Hysteroscopic myomectomy, is the surgery where the submucosal fibroid is removed from the inner wall of the uterus. To allow the procedure to be performed inside the uterus, a narrow tube with a camera is inserted through the cervix to visualize uterine activity. This procedure is used only for small fibroids. The procedure is performed under anesthesia in an operating room. Complications that may occur with this procedure include fluid overload, bleeding, scarring of the uterus, and uterine perforation.

Laparoscopic myomectomy is a less invasive procedure that allows women to experience less pain, lose less blood and return to normal activities more quickly than other treatments such as laparotomy.

Benefits of Laparoscopic Myomectomy

Compared to other treatments, laparoscopic myomectomy is considered an effective, convenient and safe procedure for removing fibroids from the uterus. Some of the advantages are as follows.

• There is less blood loss during the surgery.
• The treatment does not take long, as the patient is discharged within a day.
• Fast recovery after the surgery.

What are the risks associated with laparoscopic myomectomy?

Although laparoscopic myomectomy is associated with few complications and risks, it can present unique challenges in some cases. The following are some of the risks associated with the procedure:

• Excessive blood loss, which is higher in a larger uterus. Due to heavy menstrual bleeding, women already suffer from low blood count (anaemia). This leads to a higher risk from blood loss, and doctors always recommend improving blood counts before surgery. In addition, to prevent excessive bleeding, doctors inject medications into the area around the fibroids to compress the blood vessels and block blood flow to the uterine vessels. (Generally, patients with more than 4 fibroids and fibroids over 8 cm have an increased risk of bleeding).
• There may be some risk during pregnancy. Doctors may recommend a caesarean section if there is a deep incision in the uterine wall. This is to prevent the uterus from rupturing during labor, which is a very rare complication during pregnancy. Fibroids are associated with complications during pregnancy.
• If bleeding cannot be controlled and other abnormalities are found in addition to fibroids, there is the rare option of hysterectomy, in which the surgeon removes the uterus (there is less than a 1% chance that the uterus cannot be preserved. However, with proper techniques and experienced surgeons, this risk is much lower).
• In the case of a cancerous tumor mistaken for a fibroid, in rare cases there is a possibility that it will spread. If the tumor is removed through a small incision, it may break into small pieces and spread. As a woman ages and after menopause, this chance and risk of such a situation may increase. In other words, a mass thought to be a fibroid may rarely turn out to be a malignant tumor. (The actual and final outcome will be clear with the pathological findings after surgery!!!).
• After surgery, there may be adhesions caused by the incision made in the uterus to remove the fibroids. Due to the adhesions in the uterus, weak menstrual bleeding and fertility problems may occur.

There is a possibility that new fibroids may grow back after myomectomy. The risk is higher in young women than in women just before menopause or with very few fibroids. The risk of recurrence of fibroids within 5 years after myomectomy is 40-60%. This rate depends on the number of fibroids removed, their size, location, and the age of the patient.

How can possible surgical complications be prevented?

To minimize the risk of myomectomy surgery, doctors recommend the following preventive measures.

• Heavy menstrual bleeding can lead to iron deficiency (anemia). Taking vitamins and iron supplements may be recommended to improve blood levels during surgery.
• Treatment for fibroid reduction includes therapy with GnRH agonists, which allows the surgeon to be minimally invasive during surgery. This therapy can cause night sweats, hot flashes, vaginal dryness and menopause. These problems and discomforts do not occur after drug treatment.
• Hormone therapy is another way to avoid anemia and surgical complications. To reduce or stop menstrual flow, doctors prescribe GnRH, the gonadotropin-releasing hormone agonist, birth control pills and other hormone medications. These medications block the production of progesterone and estrogen, causing menstruation to stop and allowing the body to build hemoglobin and iron stores.

How to prepare for laparoscopic myomectomy?
Fasting for at least 8 hours is a must. In other words: No eating or drinking is allowed in the hours before surgery. The doctor's instructions must be followed before the procedure. If the patient is already taking medication, it is advisable to consult the doctor to decide whether or not to continue taking the medication.

General anesthesia is used for laparoscopic, robotic, abdominal and certain hysteroscopic myomectomies.

Tips for patients after surgery

Below are some recovery tips recommended for patients after laparoscopic myomectomy:

• Since pain is to be expected, doctors prescribe medication after surgery. The patient is advised not to lift anything heavy until the incisions are completely healed. A bandage is applied for the first few days. Since gas is used during laparoscopy, mild shoulder pain and swelling are unpleasant symptoms that you may feel on the first day. However, this is not severe.
• Doctors usually recommend waiting 4-6 weeks after surgery before having sexual intercourse.
• If the patient wants to get pregnant after the surgery, she may have to wait three to six months for the uterus to heal completely. This also depends on the type of surgery she underwent.

We can conclude that laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique with good pregnancy outcomes and an extremely low failure rate.