The surgical removal of fibroids is called a myomectomy. Intramural and subserous fibroids up to 10 cm in diameter can be removed by laparoscopic myomectomy, through two small incisions 10 mm in length, one in the umbilicus (navel) and the other a little lower down in the midline of the abdomen. Two smaller incisions only 5mm in length are made, one on either side of the abdomen about three inches from the midline. Presently only a handful of surgeons in this country offer this procedure which takes much longer and is more challenging than conventional surgery. The picture below, on the left, is of an intramural fibroid of 5 cm in diameter prior to removal laparoscopically. The picture on the right shows the appearance after removal and laparoscopic repair.
The principal difficulty with laparoscopic myomectomy is the repair of the uterus after the fibroid has been removed. This is done using laparoscopically applied sutures which requires considerable experience, training and a great deal of patience. After removal of the fibroid, it has to cut into thin strips of 10mm in diameter so that it can be removed, piecemeal through one of the laparoscopic ports. This is done with an instrument called a morcellator, seen in the foreground of the picture below. It consists of two concentric cylinders, the inner one has a sharp blade at the end and is driven to rotate by an electric motor.
Results for laparoscopic surgery performed in the best centres are comparable with conventional surgery. The advantages as far as the woman is concerned are a shorter spell in hospital, less post-operative pain and a faster return to work. However, not all fibroids are suitable for laparoscopic management and some may require conventional surgery, especially if there are three or more discreet fibroids present, or the fibroid is positioned such that access is restricted.