Hi,
The most direct answer to your question will be: yes, you can be potentially suitable for a laparoscopic myomectomy.
However, there are some factors to consider:
1. Besides size, the next most important factor will be site, meaning where is the fibroid sited in the uterus. Fibroids that are sited on the outer layer of the uterus are generally easier to deal with, as they grow outwards from the uterus and are not as deep. Some fibroids extend to the inner layer of the uterus (the endometrium), or are very low and deep in the pelvis, so these might pose more technical challenges.
2. If the fibroid is large or in a more difficult location, some doctors will consider preoperative shrinkage to optimise surgical removal. This is usually in the form of an injection or medication for 3 months prior to surgery. However the shrinkage is not permanent and hence not a long term solution.
3. Next is the consideration for pregnancy - whether via open or laparoscopic surgery, we will have to ensure all the layers are properly sutured together to provide as good healing as possible before we allow the patient to try for pregnancy.
4. Fourth will be the consideration of other options. High intensity focused ultrasound (HIFU) is a promising treatment for fibroids as it is a non surgical method using ultrasound energy to heat and destroy the fibroid core, with resultant shrinkage of the fibroid (by up to 80% volume after 1 year). Ullipristal is a oral medication that was first used for preoperative shrinkage of fibroids but now has been used for up to 18 months to treat fibroids. Uterine artery embolisation is a radiological procedure whereby the arterial supply to the uterus is blocked off, thus starving the fibroids of nutrients and oxygen with resultant shrinkage - however, this method is not suitable for women who wants to get pregnant since the blood supply to the uterus is affected.
There is no absolute "right" way to treat fibroids. Pros and cons will have to be weighed and ultimately it will have to be a decision the patient is comfortable with, and understands the advantages as well as limitations.
Best rgds
Dr Fong Yoke Fai
