This video demonstrates Laparoscopic Hysterectomy for Multiple Fibroid and Endometrioma performed by Dr. R.K. Mishra at World Laparoscopy Hospital.  Total Laparoscopic hysterectomy (TLH) has been the traditional procedure. It is an invasive procedure that is best suited for women with large fibroids, when the ovaries also need to be removed, or when cancer or pelvic disease is present. 

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight. A laparoscopic Myomectomy is a good option for fibroid removal but if the family is complete and there is abnormal uterine bleeding and the age of the patient is more than 40 years TLH is also an option. 

This patient has left side endometrioma also. Endometrioma is the presence of endometrial tissue in and sometimes on the ovary. It is the most common form of endometriosis. Endometrioma is found in 17–44% of patients with endometriosis. More broadly, endometriosis is the presence of endometrial tissue located outside the uterus.

Laparoscopic hysterectomy has emerged as a safe, effective, and minimally invasive surgical option for women suffering from multiple uterine fibroids and endometrioma, especially when symptoms significantly affect quality of life. This advanced surgical approach allows precise treatment with faster recovery, minimal pain, and better cosmetic outcomes compared to open surgery.

Understanding Multiple Fibroids and Endometrioma

Uterine fibroids are benign (non-cancerous) tumors arising from the muscular layer of the uterus. When multiple fibroids are present, they can cause heavy menstrual bleeding, pelvic pain, pressure symptoms, infertility, and anemia.

Endometrioma, commonly known as a “chocolate cyst,” is a type of ovarian endometriosis where endometrial tissue grows within the ovary. It is often associated with chronic pelvic pain, painful menstruation, dyspareunia (pain during intercourse), and infertility.

When both conditions coexist, surgical management can be complex and requires advanced laparoscopic expertise.

Why Laparoscopic Hysterectomy?

Laparoscopic hysterectomy involves removal of the uterus using small keyhole incisions with the help of a high-definition camera and specialized instruments. For patients with multiple fibroids and endometrioma, this approach offers several advantages:

Minimal blood loss

Reduced postoperative pain

Smaller scars and better cosmetic results

Lower risk of infection

Shorter hospital stay

Faster return to daily activities

Indications for Surgery

Laparoscopic hysterectomy may be recommended when:

Multiple fibroids cause severe symptoms or rapid growth

Medical treatment fails to control pain or bleeding

Endometrioma is recurrent or associated with severe endometriosis

Fertility is no longer desired

There is significant impact on quality of life

Depending on the condition, the ovaries may be preserved or removed after thorough counseling.

Surgical Technique

The procedure is performed under general anesthesia. Small incisions are made on the abdomen to insert a laparoscope and surgical instruments. The uterus is carefully dissected and detached while preserving surrounding structures such as the bladder, ureters, and bowel.

In cases of endometrioma, meticulous dissection is required to excise the cyst while minimizing damage to healthy ovarian tissue. Advanced energy devices and magnified vision help achieve precise hemostasis and safe removal.

The uterus is usually removed vaginally or by morcellation, depending on size and clinical considerations.

Postoperative Recovery

Most patients can walk on the same day of surgery and are discharged within 24–48 hours. Mild abdominal discomfort and fatigue may persist for a few days. Normal activities can usually be resumed within 1–2 weeks, with complete recovery in about 3–4 weeks.

Benefits Over Open Surgery

Compared to abdominal hysterectomy, laparoscopic hysterectomy offers:

Less postoperative pain

Faster healing

Lower complication rates

Improved patient satisfaction

Conclusion

Laparoscopic hysterectomy for multiple fibroids and endometrioma is a highly effective and patient-friendly surgical option when performed by experienced laparoscopic surgeons. It provides excellent symptom relief while ensuring safety, precision, and rapid recovery. Proper patient selection, preoperative evaluation, and surgical expertise are key to achieving optimal outcomes.
For more information:

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653