Laparoscopy and Hysteroscopy as Explained by FTG:LA
Laparoscopy and hysteroscopy are minimally-invasive surgical
procedures that can be used to remove certain types of fibroids.
They are much less drastic than an abdominal myomectomy and
since no reproductive organs are removed, future pregnancies
may be possible.
Hysteroscopic removal of fibroids requires no incisions at
all, and those whose fibroids can be treated by this method
often return to work the next day.
There is very little recovery time or pain for those who
have a laparoscopy since the incisions are quite small, only
about 5mm or not even a quarter inch long.
Laparoscopy
Laparoscopic myomectomy involves the removal of fibroids
through instruments inserted through tiny incisions near the
abdomen. One incision, in the navel, is used to insert a slim
telescope through which the procedure can be viewed by the
doctor performing the laparoscopy. Two other incisions, near
the pubic line, are used to gently insert the tools that will
perform the operation.
Although the incisions are tiny, laparoscopy is still considered
surgery and recovery takes about one week for most women.
Those fibroids that are attached to the uterus by stalks,
pedunculated myomas, are great candidates for this procedure,
as are subserous myomas, which are close to the surface of
the uterus. Submucous fibroids, which are deep in the uterine
wall, are the hardest to remove through laparoscopy, and it
is not always the best choice if there are a large number
of fibroids of any type.
After the fibroid is cut from the uterus, it is trimmed into
small pieces that can be removed through the tiny incisions.
Following their removal, the uterus is repaired and some women
are able to leave the hospital that same day. In other cases
an overnight stay is recommended, but it is usually possible
to walk later that same day, drive the next week, and return
to work the week following that.
While some women have been able to conceive and deliver babies
after having a laparoscopy, the ability of the uterus to handle
all the stress during a pregnancy is still a factor. While
some women are able to conceive and carry a child to birth
after having their fibroids removed by laparoscopic treatment,
not all can do so. Since studies on this are still uncertain,
if future pregnancies are desired you should discuss this
with your gynecologist, who may decide on a different treatment
option.
Hysteroscopy
Unlike a laparoscopy, the hysteroscopic myomectomy can only
treat submucosal fibroids, or those that are inside the uterus.
This procedure does not require any incisions to be made since
the small telescope that is used in the procedure, the hysteroscope,
passes through the cervix.
Attached to the telescope, which lets the doctor who performs
the hysteroscopy monitor the procedure on a monitor, is a
wire attachment through which electricity can pass that is
used to cut through the fibroid and cauterizes the wound.
The entire procedure typically takes less than an hour, and
while anesthetic is necessary to reduce discomfort, the woman
is able to return home that same day and can usually resume
normal activity, including work and exercise, in one or two
days.
Pregnancy rates following a hysteroscopy are good, which
makes it an excellent choice if your fibroids can be treated
by this method.
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