I am posting an edited video of an abdominal myomectomy. The uterus was 20 weeks size and contained 18 fibroids. The video has been edited to 5 minutes and shows two fibroids being removed, suture closure of the uterine muscle and the use of Seprafilm adhesion barrier. The video appears as part of the section titled: “Are Some Fibroids Too Big for an Abdominal Myomectomy?”
http://www.fibroidsecondopinion.com/abdominal-myomectomy/
Readers are welcome to post comments or questions on this blog entry about the procedure.
(NOTE: Video shows very graphic footage of an actual surgery)
2 Comments
When sharing my successful abdominal myomectomy story with women seeking treatment options, I find one of their major concerns is pelvic adhesion and how it may affect pregnancy. There is a rumor going around that abdominal myomectomy is more prone to adhesion and laparoscopic hysterectomy causes least adhesion. Could you please share your thoughts about adhesion formation among abdominal myomectomy/hysterectomy and laparoscopic(or robotic) myomectomy/hysterectomy?
Women also like to ask me why I chose abdominal myomectomy and opted out laparoscopic/robotic myomectomy (with or without pre-operative shrinkage by Lupron) which is less invasive and renders shorter recovery time. I have watched videos of these three options. My impression remains that abdominal myomectomy gives the best suturing for large fibroids. Is that still true as the technology of minimally invasive surgery advances? I think women who are having large fibroid, planning future pregnancy and debating between abdominal and laparoscopic/robotic myomectomy would love to know your opinion.
Thanks for the best video release of the week.
Su
In general, laparoscopic surgery causes fewer adhesions than abdominal surgery. I use two techniques to reduce the risk of adhesions for both types of surgery: careful suturing of the myomectomy incisions on the uterus to control oozing of blood that increases adhesions; and, use of an adhesion barrier that covers the uterine incisions for about 10 days, which allows the raw areas to heal. Then the adhesion barrier dissolves inside the body.
The right choice of abdominal or laparoscopic myomectomy for women who wish to retain fertility depends on the size, number and positions of all the fibroids. With very large fibroids (larger than 15 cm), or many fibroids (more than 7 or 8) or fibroids distorting the uterine cavity, abdominal surgery is usually recommended. But, every situation is different so there are no hard and fast rules in my practice. I think it is important to see a surgeon skilled in both abdominal and laparoscopic myomectomies who can help weigh the pros and cons for your situation.
Bill Parker, MD