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Laparoscopic and Robotic Myomectomy
Fibroids are benign (non-cancerous) growths in the uterus that can cause uncomfortable symptoms, including abnormal bleeding, abdominal and pelvic pain, painful intercourse, fertility and pregnancy complications, gastrointestinal and urinary symptoms.
There are many options for treating fibroids. One option is a myomectomy: a surgical procedure to remove fibroids while preserving healthy uterine tissue.
This surgery is typically performed using laparoscopic or robotic-assisted technology. Both methods involve small incisions to the abdomen. This approach causes less pain and blood loss, fewer adhesions (scar tissue), and a quicker recovery than a traditional, “open” abdominal myomectomy.
Who is an Ideal Candidate for a Laparoscopic or Robotic Myomectomy?
Myomectomy is an effective procedure for improving painful symptoms caused by fibroids. The benefits of myomectomy include:
- Relief from fibroid symptoms
- Protection of healthy tissue, including the uterus and ovaries
Multiple fibroids, including large fibroids, can be removed during a laparoscopic or robotic myomectomy procedure. Your surgeon will perform a thorough examination and review your MRI with you to plan the myomectomy.
A hysteroscopic myomectomy can be performed for fibroids that bulge significantly into the cavity of your uterus. Typically, you would have this type of fibroid removed prior to pregnancy. Sometimes, depending on the size or number of fibroids, an abdominal myomectomy may be required.
At the Weill Cornell Medicine Fibroid and Adenomyosis Program, you will receive an extensive evaluation by a team of fibroid specialists to determine if you are a suitable candidate for laparoscopic or robotic myomectomy.
A myomectomy is highly effective for relieving pelvic pain and pressure, and abnormal uterine bleeding due to fibroids. Robotic and laparoscopic myomectomies are safe procedures. However, all surgeries have the potential for complications. Some potential risks of myomectomy, though uncommon, include:
- Reaction to the anesthesia
- Bleeding requiring a blood transfusion
- Infection, which can be treated with antibiotics
- Damage to other organs inside the abdomen
- Blood clots after surgery
There is also a small chance of having to convert from a laparoscopic or robotic procedure to open abdominal surgery.
If you are considering getting pregnant after a myomectomy, depending on the location and how the fibroid is removed, you may need to deliver by a cesarean section.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
Misperceptions About Myomectomy
Fibroid recurrence: A myomectomy is not a cure for fibroids. Fibroids may recur after the surgery. Fibroids that your doctor does not detect during surgery, or fibroids that are not completely removed, could eventually grow and cause symptoms. New fibroids, which may or may not require treatment, can also develop.
Fibroids and infertility: Some women with infertility issues may have fibroids. Depending on the type and location of fibroids, removing the fibroids may not always be necessary to improve fertility.
Myomectomy Procedure Options
A robotic myomectomy and laparoscopic myomectomy are two similar, minimally invasive surgeries for the removal of fibroids. They both involve small incisions to the abdomen, and the procedural steps and outcomes are similar. You should be able to go home the same day after surgery for both types of surgeries.
Laparoscopic myomectomy: A laparoscopic myomectomy is a minimally invasive myomectomy. During this procedure, the fibroid is visualized using a thin, lighted scope with a camera on the end (a laparoscope). Small instruments are inserted through the incisions into your pelvis to remove the fibroid.
Robotic myomectomy: A robotic myomectomy is similar to laparoscopic myomectomy, except that the surgeon sits at a console away from the patient to control robotic surgical instruments. The surgeon controls the robot's movements steadily and precisely. This lets the surgeon get into tiny spaces more easily and have a better view of the operation compared to conventional laparoscopic surgery.
For some surgeons, the robotic approach might be helpful to remove fibroids that are less accessible by a laparoscopic approach. All surgeons at the Weill Cornell Medicine Fibroid and Adenomyosis Program are experts in both types of minimally invasive gynecologic surgeries.
What to Expect During a Myomectomy
If you are considering a myomectomy, you will meet with one of our surgeons for a consultation. The visit will include a physical evaluation and a variety of tests.
Your doctor may recommend the following to minimize the risks of myomectomy surgery:
- Iron supplements to correct iron deficiency anemia
- Medications to correct anemia
- Medications to shrink fibroids
Before the surgery, you will receive general anesthesia. Your surgeon will make three or four small incisions in your lower abdomen. Your surgeon will then place a laparoscope through one of the incisions. A laparoscope is a thin, lighted tube with a camera on one end. Small instruments will be placed into the other incision sites and will be used to perform the surgery. If the surgery is being done robotically, your surgeon will control the instruments remotely using robotic arms.
Your surgeon may need to cut your fibroids into small pieces, protected within a bag, and remove them through a small incision in the abdominal wall. If they are too large, your surgeon may have to make a larger incision in your abdomen.
Laparoscopic and robotic myomectomy procedures are typically performed as an outpatient procedure. You can expect to leave the hospital a few hours after the procedure is done.
What to Expect During Recovery
For the first few weeks after surgery, some women experience mild cramps, pain, and light vaginal bleeding for about one to two weeks. Your doctor can provide pain medication to treat your discomfort.
You are encouraged to start walking the day after surgery and can expect to return to normal activities and work in two to three weeks. Do not put anything in the vagina for two weeks; this includes intercourse and tampons.
You should not lift anything heavy or exercise strenuously until your incisions have fully healed. Your doctor will let you know when you can return to these activities.
Recovery complications to monitor: Call your doctor if your pain is not controlled by pain medication, if you experience heavy bleeding that is not your period, fever, nausea/vomiting, diarrhea, or difficulty or pain with urination.
Follow-up care: You will be scheduled for a postoperative visit for two weeks after your surgery. There will be additional follow-up visits based on your recovery. The staff and doctors at the Weill Cornell Medicine Fibroid and Adenomyosis Program are always available to answer any questions and concerns you may have.
Why Choose Weill Cornell Medicine for a Laparoscopic or Robotic Myomectomy?
There are many treatment options available to women who suffer from fibroids or adenomyosis. Treatment options range from medical therapy to surgery, with many other options in between.
The team at the Weill Cornell Medicine Fibroid and Adenomyosis Program is proud to offer the latest treatment options and provide personalized care for our patients. By getting to know and listening to our patients, we understand their needs, as well as their most difficult symptoms.
Our team includes highly trained surgeons who specialize in myomectomy. We discuss the risks and benefits of this procedure extensively with interested patients. Our specialists carefully evaluate each patient to determine if they are suitable candidates for a laparoscopic or robotic myomectomy procedure.
Our team of minimally invasive gynecologic surgeons and interventional radiologists collaborates with other specialists in reproductive health, integrative medicine, and nutrition to help patients receive high-quality, personalized care.