The treatment for removing the fibroids from the uterine muscle is known as MYOMECTOMY. It is a specialised operation done by reproductive surgeons who have considerable experience in preserving the uterus for future fertility. Hysterectomy should not be a complication of this surgery in experienced hands. It is important that the uterine lining be not entered to allow normal birth later, and that the muscle is adequately repaired in many layers. This operation is traditionally done through a LAPAROTOMY via a 'bikini' or 'up and down' incision. When the fibroids are less than 5 and less than 18 weeks size LAPAROSCOPIC myomectomy can be performed. There are fewer doctors who can perform this than by laparotomy as the need to accurately suture the muscle laparoscopically is a difficult skill. Inadequate Suturing has led to reports of uterine rupture in pregnancy and labor.
The advantage of lap myomectomy is that patients can go home the same or next day and be back to work in 1-2 weeks. However it is important that the surgery be as complete as by laparotomy or any advantage is lost. Our center has pioneered the technique of VERTICAL DEEP LAYERED REPAIR of the muscle by laparoscopic suturing. This creates a strong repair allowing normal VAGINAL delivery even after removing larger intramural fibroids. The use of an electric morcellator to remove the fibroid tissue in long strips has made the surgery speedier so that 18 week size .fibroids can be treated in 2 hours.It does not matter whether the fibroids are removed by laser, harmonic scalpel, knife or electrosurgery. The skill of the surgeron is paramount to results.