Uterine fibroids, also known as myomas or leiomyomas, are benign tumors that grow within or on the outer layers of the uterus. They are made up of muscle cells and fibrous connective tissue. While fibroids are usually asymptomatic, common symptoms can include heavy or prolonged menstrual bleeding, abdominal pain and pressure, frequent urination, difficulty emptying the bladder, painful intercourse, lower back pain, or a feeling of fullness in the lower abdomen.
Fibroids are the most common benign tumors found in women. It is estimated that 20-40% of women have uterine fibroids by age 35 and up to 80% of women have fibroids by age 50. African American women and women over 40 years of age are more likely to develop symptomatic fibroids that require treatment.
Myomectomy as a Fibroid Treatment Option
It is a surgery to remove uterine fibroids while keeping the uterus intact. It is one of the most commonly performed surgical procedures for women with symptomatic fibroids who want to maintain their fertility. Myomectomy can also relieve fibroid symptoms and prevent further complications.
Several factors play a role in deciding if fibroidectomy is the right treatment option, including a woman's desire for future fertility, fibroid size and location, overall health, and response to previous medical management. Different surgical techniques enable myomectomies to be performed through traditional open abdominal incisions or with minimally invasive approaches such as laparoscopy or hysteroscopy.
Laparoscopic Myomectomy
Laparoscopic fibroidectomy, or minimally invasive fibroidectomy, is done through several small incisions using a camera and surgical instruments. The surgeon views the procedure on a video monitor inside the abdomen rather than through a large abdominal incision. This type of surgery allows for quicker recovery times compared to traditional open fibroidectomy.
Laparoscopic procedures have multiple benefits for patients including less postoperative pain, shorter hospital stays, less blood loss and scarring, and a faster return to normal activities. For the appropriate candidate, laparoscopic surgery may carry fewer risks than an open procedure.
However, laparoscopic myomectomy also has some limitations. Smaller incisions make the procedure more technically challenging, prolonging the surgery time in some cases. Fibroids located deep in the muscle of the uterus or too large in size may not be amenable to a minimally invasive approach. Patient factors like obesity, previous abdominal surgeries, or large fibroid burden could also necessitate converting to open surgery.
Global Advances in Laparoscopic Surgery
In the past decade, technological innovations have helped drive global advancements in minimally invasive gynecologic surgery capabilities. Improved laparoscopic devices including high-definition cameras, articulating instruments, and uterine manipulators provide surgeons with improved visualization and surgical precision inside the abdomen.
Advanced energy technologies like bipolar devices and ultrasonic shears allow for dissection and suturing of tissues with greater hemostasis and reduced risks of complications. Developing simulation platforms and surgical training programs worldwide have enabled general gynecologists to learn the necessary skills for performing minimally invasive fibroid surgeries.
Global Trends in Fibroid Treatment
As options like uterine artery embolization and focused ultrasound become established nonsurgical treatment alternatives, there has been a downward trend in total abdominal hysterectomies performed for fibroids in many countries. At the same time, the global rates of minimally invasive hysterectomies and myomectomies have significantly increased over the past decade according to International Federation of Gynecology and Obstetrics reports.
In developing nations, efforts to establish laparoscopic surgery training centers are expanding women's access to fibroid treatments that preserve fertility. Regional fibroidectomy clinical guidelines now emphasize the benefits of minimally invasive approaches when feasible. Reproductive health advocacy groups promote public education about fibroid symptoms and range of treatment options available globally.
With technological and surgical advancements, more women worldwide affected by symptomatic uterine fibroids now have the option of a minimally invasive fibroidectomy. When performed by an experienced gynecologic surgeon, a laparoscopic myomectomy can effectively treat fibroids while avoiding a large abdominal incision. This fertility-sparing procedure allows for a quicker recovery compared to open surgery and provides women relief from fibroid symptoms. Ongoing improvements in laparoscopic techniques and skills training will likely lead to continued growth in global access to minimally invasive fibroid treatments in the future.
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