Laparoscopic Myomectomy in 21st Century
Fibroids shrink at the menopause to 50% with their size but last a lifetime. GnRh agonists e.g. Lupron, Synarel, Busarelin are medications given by injection or nasal spray that create a brief menopause allowing shrinkage. However in many patiemt on stopping medication the fibroid regrows to its original size. Therefore long term treatment of laparoscopic myomectomy are not indicated because they drugs cause severe menopausal symptoms and osteoporosis. The affected patients of laparoscopic myomectomy can use them for 1-3 months before surgery to lessen the hemorrhage of surgery. Treatments for detaching the fibroids from the uterine muscle is called MYOMECTOMY. This is a specialised operation made by reproductive surgeons who've considerable experience in preserving the uterus for future fertility. Hysterectomy shouldn't be a complication with this laparoscopic myomectomy surgery in experienced hands. It is vital that the uterine lining be not entered during laparoscopic myomectomy allowing normal birth later, understanding that muscle is sufficiently repaired in many layers. This operation of myomectomy is traditionally carried out by a LAPAROTOMY using a 'bikini' or 'up and down' incision. In the event the fibroids are under 5 and much less than 18 weeks sizelaparoscopic myomectomy can be. The patient will find fewer laparoscopic surgeon who can perform this when compared with laparotomy as the should accurately suture the muscles laparoscopically is a difficult skill. Inadequate Suturing has generated reports of uterine rupture while being pregnant and labor.
The main advantage of laparoscopic myomectomy is that patients may go home the same or following day and stay returning to be employed in 1-2 weeks. Yet it's critical that the surgery be as complete as by laparotomy or any advantage sheds. Our center has pioneered the strategy of laparoscopic myomectomy VERTICAL DEEP LAYERED REPAIR from the muscle by laparoscopic suturing. This creates a strong repair allowing normal VAGINAL delivery despite removing larger intramural fibroids. The usage of an electric powered morcellator to get rid of the fibroid tissue in long strips has made the laparoscopic myomectomy speedier in order that 18 week size fibroids can usually be treated by 50 % hours.Regardless of perhaps the fibroids are removed by laser, harmonic scalpel, knife or electrosurgery. The skill of the surgeron is key to results in laparoscopic myomectomy.
This is another technique of laparoscopic myomectomy pioneered at World Laparoscopy Hospital where large multiple approximately 24 weeks size can be taken off via a 2 inch bikini incision. Patients may go home the next day after surgery. Submucus fibroids are removed by inserting a hysteroscope by use of loop electrode over the vagina with an electrical loop is used to removed the protruding part. That is rapid and efficient minimal access surgery with no need of laparoscopy. Estrogen can be used after surgery to advertise uterine endometrial lining regrowth.
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