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• When to undergo laparoscopic myomectomy?

If you have symptoms of fibroid like heavy and prolonged bleeding, painful periods, mass on   the abdomen, pressure symptoms like frequency of urination and constipation are the indications of surgery, in young patients who has not completed the family we recommend myomectomy. In those who has completed the family and aged we prefer to do hysterectomy, final option always are for the patients .Asymptomatic patients we keep them for observation.

• When can I conceive after myomectomy and does myomectomy surgery leads to Infertility?

Pregnancy can be planned after 4-6 months, depending on the size and location of fibroid. Fibroid removal surgery does not cause infertility, if any fibroids causing infertility, such as submucosal fibroids can be cured after fibroid removal .

• I have huge and multiple fibroid can it be removed laparoscopically?

Yes huge and multiple fibroids can be removed through laparoscopically. Until we have space to put laparoscopy instruments inside the abdomen we can remove fibroids laparoscopically .we are routinely removing fibroids weighing more than 1000gms laparoscopically  .

• I have multiple previous surgeries can we go for laparoscopic fibroid removal /Uterus removal or open surgery?

Of course we can do laparoscopy in previous surgeries. Once we insert camera in to the abdomen, we look for the adhesions, in case of severe adhesions which carries the risk of injury to the important organs, we may decide to go for open surgery at the same sitting. We have not come across such situation till now, we do routine pre-operative counselling in very high risk patients about rare possibility of conversion to open surgery.

• What is hysterectomy

A hysterectomy is a surgical procedure whereby the uterus is removed. This is the most surgery following caesarean  in women. Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

• Indications for hysterectomy

 A woman may have a hysterectomy for different reasons, the most common one is Uterine fibroids that cause pain, bleeding, or other problems

Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal

Abnormal uterine bleeding which happens due to hormonal imbalance if not responding to medical treatment.

Adenomyosis of uterus (enlargement of uterus)

Endometriosis with severe pelvic pain

Cancer of uterus, cervix and ovary.

• What is fibroid and how common it is

Uterine fibroids are common non-cancerous (benign) growths that develop in the muscular wall of the uterus. Fibroids are the most common tumours of the uterus, fibroids are also called leiomyoma, leiomyomata, myoma and fibromyoma.

Size may vary from small, undetectable by the human eye, to huge size that can distort and

enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much

that  it reaches the rib cage. Prevalence of Uterine Fibroids 20- 40 per cent of women aged 35 yrs

and older have uterine fibroids. African women are at a higher risk for fibroids

• How will I know that I have fibroids

Most fibroids do not

cause symptoms. Only 10 to 20 % of women who have fibroids require treatment.

If you are suffering from any of these symptoms consult your gynaecologist, on examination or by ultrasonography we will be able diagnose fibroids .

• Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots; this can lead to anemia
• Pelvic pain and pressure
• Pain in the back and legs
• Pain during sexual intercourse
• Bladder pressure leading to a frequent urge to urinate
• Pressure on the bowel, leading to constipation and bloating
• Abnormally enlarged abdomen

• What is the cause of fibroid, can I avoid getting fibroids?

No specific risk factors that promote the formation of fibroids have been identified;, but it has been found that its growth depends on estrogen. They have shown increasing in size in reproductive age, during pregnancy and usually regress following menopause. Certain research also shows that genetics and insulin-like growth factor can also cause fibroids. Some, researchers have found that the women most likely to develop fibroids are those who

• have never been pregnant,
• have a family history of fibroids,
• African-American.

Unfortunately, because the cause of the tumors is not known exactely, there is no way to prevent the onset of uterine fibroids. If a woman falls into any one of the categories that make her most at risk, she should be checked for fibroids at each visit to her doctor.

• Treatment options for fibroid uterus

Observation

Many women with uterine fibroids experience no signs or symptoms, or only mild signs and symptoms. Observation with sonography at routine intervals is the best option.

Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them . Medications include includes mainly hormones.

MRI-guided focused ultrasound surgery (FUS) is:

• A noninvasive treatment optionfor uterine fibroids that preserves your uterus, no cuts and is done on an outpatient basis.
• Done inside an MRI scannerdone with a high-energy ultrasound transducer for treatment. After localisingthe fibroid, the ultrasound transducer focuses sound waves into the fibroid to heat and destroy small areas of fibroid tissue.
• Newer technology. Researchers are learning more about the long-term safety and effectiveness

Uterine artery embolization. Small particles are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.

Minimally invasive procedures

They include:

• Laparoscopic  Done in young patients and in those who wants to preserve uterus for future pregnancy. In a myomectomy, surgeon removes the fibroids, leaving the uterus in place. With advancing technology,  we are now able to remove multiple and huge fibroids   laparoscopically.
• Hysteroscopic myomectomy.This procedure may be an option if the fibroids are contained inside the uterine cavity
• Laparoscopic Hysterectomy.For those who have completed the family and old patients.
• Risk of developing new fibroids

For all procedures, except hysterectomy, small microscopic fibroids doesn’t detect during surgery can eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. Those with single fibroid recurrence risk is low when compared to multiple fibroids. Some research has shown 5-30% recurrence over 5-10 years.

• What is ovarian cyst, do all ovarian cysts need surgeries.

Ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance. 95% of the ovarian cysts are non-cancerous. The treatment of an ovarian cyst depends upon diagnosis, simple cysts usually needs observation, persistent cyst and complex cysts needs surgery.

• why laparoscopy in infertility is required

We call as Infertility if the women not able to conceive in spite of having frequent, unprotected sex for at least a year. Infertility can be from both partners and unexplained

Laparoscopy in infertility id done to check your fallopian tubes, ovaries and uterus, it can identify endometriosis, scarring, blockages the fallopian tubes, or any problems with the ovaries some of these things which are not picked with ultrasonography.  If any problems are found then they can sometimes be corrected with operative laparoscopy.

• Diagnostic laparoscopy

Laparoscopy can be used for diagnosis, treatment or both. A diagnostic procedure can turn into treatment if some findings are noted.

Some reasons for diagnostic laparoscopy are:

• unexplained pelvic pain
• unexplained infertility
• history of pelvic infection
• What is hysteroscopy and for what it is done.

Hysteroscopy in which camera (Hysteroscope) is inserted through birth canal in to the uterus to look in to the lining of the uterus to diagnose and treat abnormal conditions like polyps, fibroids, septum and  other causes of abnormal uterine bleeding inside the uterus. Advantage is that there won’t any cuts on the abdomen

 

 

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