Uterine fibroids, also called leiomyomas or myomas, are noncancerous growths that develop from the muscle tissue of the uterus. They are among the most common gynecological problems in women of reproductive age. While many fibroids are asymptomatic, others can cause heavy menstrual bleeding, pelvic pain, infertility, and pressure symptoms. For women who wish to preserve their uterus, surgical removal of fibroids — known as myomectomy — is often recommended. Among the available techniques, laparoscopic fibroid removal has emerged as a minimally invasive, safe, and effective method with excellent outcomes.

Understanding Fibroids and Their Impact

Fibroids vary widely in size, number, and location. They may be:

Subserosal – growing outward from the uterine surface.

Intramural – embedded within the uterine wall.

Submucosal – protruding into the uterine cavity, often associated with infertility and heavy bleeding.

Symptoms depend on fibroid size and location. Large fibroids can distort the uterus, leading to pressure on the bladder or bowel, while multiple fibroids can interfere with implantation and pregnancy. When medical therapy fails, surgical removal is often the best option.

What Is Laparoscopic Fibroid Removal?

Laparoscopic fibroid removal, also called laparoscopic myomectomy, is a procedure where fibroids are excised using minimally invasive keyhole incisions. A laparoscope (a thin tube with a camera) and specialized instruments are inserted into the abdomen through small cuts, typically 5–10 mm in size. The surgeon visualizes the uterus on a high-definition monitor and removes the fibroids while preserving the uterus.

This procedure is particularly suitable for women who:

Wish to maintain fertility and avoid hysterectomy.

Have symptomatic fibroids causing bleeding, pain, or pressure.

Have fibroids resistant to medical treatment.

Advantages of the Laparoscopic Approach

Compared to open abdominal myomectomy, laparoscopic fibroid removal offers several benefits:

Minimally invasive – Smaller incisions, less trauma.

Reduced postoperative pain – Patients need fewer analgesics.

Faster recovery – Return to normal activities within 1–2 weeks.

Shorter hospital stay – Most patients are discharged within 24–48 hours.

Minimal blood loss – Advanced techniques help reduce intraoperative bleeding.

Better cosmetic results – Scars are tiny and barely visible.

Surgical Technique
Preoperative Preparation

Patients undergo ultrasound or MRI to assess the number, size, and position of fibroids.

Hemoglobin levels are optimized to correct anemia caused by heavy bleeding.

Medications such as GnRH analogs may be given preoperatively to shrink fibroids and reduce blood loss.

Anesthesia and Positioning

The surgery is performed under general anesthesia. The patient is placed in the lithotomy position with Trendelenburg tilt, allowing better visualization of the pelvis.

Procedure Steps

Port placement – Usually 3–4 small incisions are made for the laparoscope and instruments.

Visualization – The abdomen is inflated with carbon dioxide to create space for maneuvering.

Uterine incision – The surgeon makes a precise incision on the uterine wall overlying the fibroid.

Fibroid enucleation – The fibroid is carefully dissected and separated from surrounding myometrium.

Uterine repair – The defect in the uterine wall is sutured in layers using laparoscopic suturing techniques to restore uterine integrity.

Specimen removal – Fibroids are extracted using a morcellator or via mini-laparotomy, depending on size and institutional protocols.

Final check – Hemostasis is ensured, and the abdominal cavity is irrigated before closure.

Postoperative Care

Recovery after laparoscopic myomectomy is usually rapid:

Pain management – Mild analgesics are sufficient.

Early mobilization – Encouraged within hours of surgery to prevent complications.

Diet – Oral intake resumes the same day or next morning.

Hospital stay – Typically 1–2 days.

Activity – Normal routine within a week, but heavy lifting and strenuous exercise should be avoided for 4–6 weeks.

Fertility counseling – Women are advised to wait 3–6 months before attempting conception to allow proper uterine healing.

Outcomes and Benefits

Studies show that laparoscopic fibroid removal offers high success rates in symptom relief:

Reduction of heavy menstrual bleeding in over 80% of patients.

Improvement in fertility outcomes, particularly in women with submucosal or intramural fibroids.

Improved quality of life with relief from pelvic pain, pressure, and bloating.

Preservation of the uterus, which is crucial for women desiring pregnancy.

Risks and Considerations

While safe, laparoscopic fibroid removal carries some risks:

Intraoperative bleeding – Fibroids are highly vascular.

Conversion to open surgery – May be required in very large or multiple fibroids.

Adhesion formation – Scar tissue may develop postoperatively.

Uterine rupture in pregnancy – Rare but possible if the uterine wall is not adequately repaired.

Recurrence – New fibroids can develop over time, especially in younger women.

Careful patient selection and surgical expertise are key to minimizing these risks.

Conclusion

Laparoscopic fibroid removal is a safe, effective, and uterus-sparing surgery for women with symptomatic fibroids. By combining the benefits of minimally invasive surgery with precise myomectomy techniques, it provides symptom relief, preserves fertility, and ensures faster recovery compared to open surgery. As technology advances and surgical skills expand, laparoscopic myomectomy continues to play a central role in modern gynecological practice, offering women a chance to lead healthier lives with minimal disruption.