Watch this detailed video on Laparoscopic Myomectomy for Multiple Myoma. Learn step-by-step how minimally invasive surgery is performed to remove multiple fibroids safely and effectively. This video explains the procedure, benefits, recovery, and expert tips from experienced laparoscopic surgeons.

Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus. ... It is known that uterine fibroids are estrogen dependent. During pregnancy these fibroids increase in size, whereas in the puerperium and menopause they shrink. In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope ― a narrow tube fitted with a camera ― into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. Robotic myomectomy. Instruments are inserted through small incisions similar to those in a laparoscopic myomectomy, and the surgeon controls movement of instruments from a separate console. Sometimes, the fibroid is cut into pieces and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

Uterine fibroids, also known as myomas, are non-cancerous growths in the uterus that affect a significant number of women during their reproductive years. While single fibroids are often easier to manage, multiple myomas present a more complex challenge, especially for women wishing to preserve fertility. Laparoscopic myomectomy, a minimally invasive surgical technique, has emerged as a safe and effective solution.

Understanding Multiple Myomas

Multiple myomas refer to the presence of two or more fibroids in the uterus. These fibroids vary in size, number, and location—some may be subserosal (on the outer surface), intramural (within the uterine wall), or submucosal (beneath the uterine lining). Symptoms often include:

• Heavy menstrual bleeding

• Pelvic pain or pressure

• Recurrent pregnancy loss or infertility

• Urinary or bowel disturbances due to pressure effects

Traditional open surgery (laparotomy) was once the standard approach, but it involved longer recovery, higher blood loss, and significant post-operative discomfort.

What is Laparoscopic Myomectomy?

Laparoscopic myomectomy is a minimally invasive procedure in which fibroids are removed using small incisions (usually 0.5–1 cm) in the abdomen. A laparoscope—a thin tube with a camera—is inserted to provide a clear view of the uterus, and specialized instruments are used to excise the fibroids.

Advantages for Multiple Myomas

• Minimal Invasiveness: Reduced trauma to surrounding tissues compared to open surgery.

• Reduced Blood Loss: Advanced techniques like vasoconstrictive agents and meticulous suturing minimize bleeding.

• Fertility Preservation: The uterus is reconstructed carefully, maintaining its integrity for future pregnancies.

• Faster Recovery: Patients often return to daily activities within 1–2 weeks.

• Less Postoperative Pain and Scarring: Small incisions lead to better cosmetic results and less discomfort.

Surgical Technique

1. Preoperative Planning: Imaging studies like ultrasound or MRI help identify the number, size, and location of fibroids.

2. Anesthesia: The procedure is performed under general anesthesia.

3. Port Placement: Small incisions are made for the laparoscope and surgical instruments.

4. Fibroid Enucleation: Each fibroid is carefully dissected from the uterine wall while preserving healthy tissue.

5. Uterine Reconstruction: Multiple-layer suturing ensures the structural integrity of the uterus.

6. Specimen Removal: Fibroids are removed using a morcellator or contained extraction methods.

7. Closure: Small incisions are closed with minimal scarring.

Challenges in Multiple Myomas

• Complexity of Surgery: Multiple fibroids require meticulous dissection and longer operative time.

• Blood Loss Risk: Larger and numerous fibroids can increase intraoperative bleeding.

• Recurrence: Even after successful removal, fibroids may recur, necessitating follow-up.

Recovery and Postoperative Care

Patients typically experience:

• Mild abdominal discomfort

• Early ambulation and diet resumption

• Short hospital stay (usually 24–48 hours)

• Follow-up imaging to monitor for recurrence

Lifestyle adjustments and medical therapies may be recommended to prevent new fibroid formation.

Conclusion

Laparoscopic myomectomy for multiple myomas represents a modern, fertility-sparing approach to uterine fibroid management. It combines the benefits of minimal invasiveness with the precision required to treat complex cases effectively. With advances in surgical techniques, women suffering from multiple myomas can now enjoy improved quality of life, faster recovery, and preservation of reproductive potential.

Tip: Consultation with an experienced laparoscopic surgeon is essential, especially for women with multiple or large fibroids, to ensure optimal outcomes.