Am I suitable for laparoscopic myomectomy fibroid removal if I have a large fibroid?Women's Health Gynaecology
I have a fibroid measuring 8.7 by 7.4 by 7.8cm. What type of surgery is recommended for my large fibroid if I choose to get treated? Would I still be a suitable candidate for laparoscopic myomectomy given the size of the fibroid? Thanks.
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.
Dr Fong Yoke Fai
The surgical considerations for treatment of fibroid include:
- Mode of surgery - Laparoscopic vs Open Surgery
- Extent of surgery - Myomectomy (removal of fibroid only) vs Hysterectomy (removal of the entire womb)
The type of surgery recommended for fibroids will depend on a few factors such as:
- a patient's age
- prior abdominal surgeries before (including caesearean section)
- reproduction desire
- whether your family is completed
- the size, location and number of fibroids
- if there are any other symptoms or problems associated with it
- patient's own medical history and condition
Whether you are suitable for a laparoscopic myomectomy will depend on what you want, your expectations as well as the expertise of your operating surgeon.
In general, a 8.7cm can usually be removed via laparoscopic myomectomy (again, depending on the surgeon). However, you must be aware of the risks vs benefits of a laparoscopic vs open approach and weigh the options yourself before deciding.
The benefits of laparoscopic surgery include much smaller scar and faster recovery time post op.
However, laparoscopic myomectomy carries the risk of morcellation (surgically cutting the fibroid into smaller pieces to remove through the key hole port).
The concern with morcellation is the rare risk of potentially spreading abnormal cells around the abdominal cavity if the cells in the fibroid turn out to be bad.
Again, the main thing is for you to have a detailed discussion with your gynaecologist so that you can weigh your options carefully before making a decision that you are comfortable with.
Dr Michelle Chia