Fibroids are also known as leiomyoma.They are benign tumor of the uterus. This tumor
arises from the uterine tissue.It is seen in 40-50% of women in their reproductive age group.
Symptoms due to fibroid depend on the location, size and number of the fibroid .Most
fibroids are asymptomatic and need waitful management.
Type of fibroid-Depending on the location they are classified as Subserous ,Intramural and
Submucous fibroid.They can present as a solitary fibroid or can be seen in more numbers and
can present in combination of subserous,intramural and or submucous.
Cause-the exact cause for fibroid is still unknown .
Common complaints seen in Fibroid uterus are – Increased Menstrual flow ,clot,painful
cycles,shortened menstrual cycles.Large fibroid have pressure symptoms and may be the
cause for increased urinary frequency or difficulty in passing urine also sometimes may
complaint of bloating.
Treatment
Waitful management is advised in asymptomatic fibroid.
Medications cannot cure fibroid but they are used in a select few cases .
Surgery – 1.Minimally Invasive Myomectomy
2.Hysteroscopic Myomectomy
3.Minimally Invasive Hysterectomy
Myomectomy– Surgical removal of fibroid while conserving the uterus is done in
myomectomy.Techniques for myomectomy are Laparoscopic myomectomy and Robot
assisted laparoscopic myomectomy.
Laparoscopic Myomectomy.
In this technique General anaesthesia is preferred.Pneumoperitoneum is created in the
abdominal cavity using medical grade gas. Small cut of half centimeter are made on the
abdomen ,3-4 in numbers and one 1cm port is used around umbilicus for introducing
telescope for vision into the pelvis.In this video laparoscopy procedure the surgeon visualises
the operation on a monitor connected to the laparoscope.Energy based device is used for
separation of fibroid which is then put in a endobag in the pelvic cavity and cut into smaller
pieces.The endobag with smaller fibroid pieces is then removed from the pelvis and sent for
examination.The procedure takes from 60 min to 180 minutes depending on the fibroid
numbers and size.
Robot assisted Laparoscopic Myomectomy
In this technique General anaesthesia is used.And similar to Laparoscopy technique 3-4 ports
of less than 1cm are introduced into the abdomen.1visual bed side Robotic units and 3
bedside Robotic units are placed.Surgeon sits on a Robotic console and controls the bedside
units arms for performing the surgery with amplified vision and more precision.
Post-Operative care in Minimally invasive surgery
6hrs after the surgery patient is started on liquid diet and mobilized. Next day catheter
draining the urine is removed and once the bowel activity is resumed soft diet is
started.Discharge is advised on day 2 evening or day 3 morning of surgery.They are advised
to walk and do all their necessary activity depending on the pain tolerance.Antibiotics are
stopped on day 5 of surgery and they are to revisit the consultant .
Hysteroscopic submucous Myomectomy
This procedure can be performed in spinal anesthesia/general anaesthesia.It is performed
through vagina /birth passage without cutting the passage.A Hysteroscope resection assembly
is used to enter the uterine cavity through the vaginal passage .Submucous fibroid is
visualised in the uterine cavity and resected using energy based device. It is a day care
surgery .Post surgery some amount of menstrual spotting/bleeding may continue for a month.
Minimally Invasive Hysterectomy
Laparoscopic Hysterectomy
This technique is performed under General anaesthesia.Medical grade gas is used for
creating pneumoperitoneum into the abdominal cavity.Small cut of half centimeter are made
on the abdomen ,3-4 in numbers and one 1cm port is used around umbilicus for introducing
telescope for vision into the pelvis.In this video laparoscopy procedure the surgeon visualises
the operation on a monitor connected to the laparoscope.Energy based device is used for separation of uterus from its attachments in the pelvis and the organ is delivered through
normal vaginal passage.The procedure takes from 60 min to 180 minutes.
Robot assisted Laparoscopic Hysterectomy
In this technique General anaesthesia is used.And similar to Laparoscopy technique 3-4
ports of less than 1cm are introduced into the abdomen.1visual bed side Robotic units and 3
bedside Robotic units are used during the surgery.Surgeon sits on a Robotic console and
controls the bedside units arms for performing the surgery with amplified vision and more
precision.Uterus is separated from its attachments in the pelvic cavity and delivered
vaginally.
Fibroid is excessive growth of uterine musculature which forms a localized swelling in the uterus.
Depending on the location, size and site the fibroids are classified as:
1. Subserous fibroid: The location of the fibroid is on the surface of the uterus.
2. Submucous fibroid: The fibroid is situated within the uterine cavity.
3. Intramyometrial fibroid: The fibroid is within the body of the uterus.
Rarely, fibroids of the above mentioned variant may coexist.
Epidemiology: Fibroid is seen in 50% of the reproductive age group of women. It is one of the common causes for infertility in women. The incidence is on the rise due to early menarche, late marriage, poor breast feeding. There is association of genetic inheritance in fibroids.
➾ Abdominal pain and lump in tummy
➾ Menstrual irregularities: heavy painful bleeding, prolonged cycles, clots.
➾ Nausea, vomiting, bowel obstruction symptoms
➾ Urinary complaints: Large fibroids cause pressure symptoms giving rise to frequent urination, retention of urine, descent of reproductive organ.
➾ Dyspareunia (painful intercourse)
➾ Infertility
➾ A large population of women with fibroids is asymptomatic and need no treatment.
Occasionally as the size of fibroid enlarges, it may give rise to severe abdominal pain and surgical diagnostic dilemma.
➾ Abdominal sonography is a very reliable tool for the diagnosis of fibroids.
➾ CT scan and MRI are performed in cases where there is diagnostic dilemma.
Medical managementfor fibroids is a non-definitive treatment modality and should be exercised only in selective cases.
➾ The right approach depends on the size, site, and location of fibroid.
➾ When reproductive function is to be preserved, Laparoscopic Myomectomy is performed in subserous and partially intramyometrial fibroid.
➾ Hysteroscopic Myomectomy is performed in submucous fibroid.
➾ In cases of infertility, Diagnostic Hysteroscopy and Laparoscopy both have to be performed and accordingly the fibroid is removed.
➾ Laparoscopic Hysterectomy is performed for multiple fibroids and in whom reproductive function is not desired.
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