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Big Fibroid operation refused in U.K & Was done successfully laparoscopically in India
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  Laparoscopic Fibroid  
 

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Indication:

Performed for Infertility, Menorrhagia, pain in lower abdomen & in P/v examination and TVUSG showing adnexal mass.

Objective:

Fibroid less than 5 cms may be asymptomatic & may not be required to be removed. Fibroid with Menorrhagia, Symptomatic Fibroid like Dysmenorrohea, pressure symptoms on surrounding organs like bladder & rectum, Infertility required to be removed. Expert TVUSG with Color Doppler should be done to exclude Adenomyosis. Patient must be counseled for the possibility of Adenomyosis before fibroid surgery. Fibroid mapping should be done for size, extent and locations of different fibroids before surgery as it helps surgeon to access them during surgery. Sub mucus fibroid is approached hysteroscopically. Video helps in conveying the quality of Mymectomy we have done.  Adequate Laparoscopic suturing is mandatory to offer scar integrity and safety in next pregnancy following r Mymectomy surgery. Adequate Haemostasis & copious irrigation with ringer lactate helps in preventing post-operative adhesions. This surgery requires lot of experience & expertise. Patient can be discharged on the same day.

Benefits of Laparoscopy Surgery:

  1. Shorter Hospital stay,
  2. Earlier return to your routine work,
  3. Cosmetically vary small scar,
  4. Less pain after operation,
  5. Best fertility enhancement & Fertility results following Laparoscopy,
  6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.
  8. Associate endometriosis found during laparoscopy also helps us to treat them simultaneously.  

Pre-operative Check Lists:

  • Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.etc.); Pelvic Trance vaginal USG report, Blood tests for Tumor markers. MRI to exclude the possibility of Adenomyosis before surgery.
  • Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report c etc.) If the couple is infertile.
  • Operation planned from 4th to 10th day of Menstrual Cycle if Laparoscopy is done for Infertility.
  • Enema & preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: Two of 5 mm size & one of 10 mm size.

Average Stay in Hospital:
8 to 12 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
30-40 minutes depending upon the no. & size of fibroids.

Average Blood loss during Surgery:
50-80 cc. For bigger size fibroid blood loss may be more.

Average time after operation to resume normal activities/work:
Within 24 hours. Most begin feeling much better within one day.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside the navel, and another is usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from pelvic organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable.

Tubal testing is done to check their Patency by pushing methyline Blue dye from below. Uterine wall & Fibroid capsule is infiltrated with 10% pitressin around the attachment of fibroid with uterus. Adequate incision is made with edge of spatula on the bulge of Fibroid with Monopolar spatula using unmodulating current, till fibroid is reached. Fibroid is fixed with Myoma screw and from another port spatula or suction irrigation cannula is used to dissect out the fibroid from its bed gently. Any bleeders or blood vessels are sealed with bipolar desiccation. Suction irrigation done in the bed to identify any bleeder and desiccated with Bipolar. Uterine defect in the uterus is closed with No. 1 Vicryl suture and with figure of 8” stitch to obliterate the defect adequately, so most the dead space is taken care of.  Left 10 mm port is used for introduction of Morcellator. Fibroid is grasped with 5 mm claw forcep from Lt. Port and Fibroid is grasped with 10 mm claw forcep from 10mm lt lateral port. Fibroid is morcellated on vision to prevent injury to surrounding organs. Long fibroid strips are made and removed with help of Morcellator. Haemostasis checked. Fibroids send for HPE.

Post-operative Course:

  • Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
  • Patient can take fluids 6-8 hours after laparoscopy & light food after 8-10 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
  • Most of the patients can walk normally without support and can take normal diet 12 hours after the laparoscopy.
  • She can be discharged on the same day or next day of the operation.
  • Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
  • Patient can do her normal activity within 24 hours after laparoscopy.
  • Patient is advised to take antibiotics & analgesic tabs. For 5 days following laparoscopy.
  • Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
  • Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

 

 

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