A woman facing fibroids has a range of treatments available – from medication to removal of the uterus. McLeod OB/GYN Gary Emerson, MD, explains one robotic-assisted surgical treatment that can preserve a woman’s fertility.
Here’s a summary of Dr. Emerson’s comments:
For fibroids on the outside of the uterus or intermuscular, we can use a procedure called a myomectomy. It can be done abdominally, laparoscopically or robotic-assisted. When we do an abdominal surgery, we make an incision in the lower part of the abdomen, pull up the uterus, dissect out the fibroids and then close the tissue up. Basically, a laparoscopy is the same approach, except we do it through some small incisions.
There’s a risk of about half a percent of fibroids being cancerous. It’s a very aggressive cancer. Unfortunately, it’s difficult to diagnose preoperatively. To remove fibroids laparoscopically, we go in with a scope and several instruments. We make several small incisions and dissect out the fibroid. We use laparoscopic instruments to sew the uterus back together where the fibroid was situated.
Robotic instruments allow us to have another degree of movement. Laparoscopic instruments can be pushed, pulled, rotated and turned. However, robotic instruments have a wrist, so it allows you to have a little more flexibility. It’s easier to sew with robotic instruments, adding flexibility for the surgeon.
Laparoscopic and robotic recoveries are faster. Less pain. There’s usually less blood loss and less risk of infection. With laparoscopies, most folks are back up to 100 percent of their daily activity in two weeks. If we do it abdominally, depending on the size of the incision, it may be a 4- to 6-week recovery.
I have a hard time, occasionally, with patients who feel like they may want fertility but they’re not sure. In these cases, a lot of my time is spent discussing the difference between a myomectomy and a hysterectomy. For women who are certain they don’t want more children, a hysterectomy is a much easier operation than a myomectomy. There’s less blood loss, fewer surgical complications and faster recovery. Myomectomies are a bigger operation, but in patients who want to retain fertility, it’s really the only choice.