Surgical Management of Fibroids

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• 0:03Introduction
• 0:45Hysteroscopic myomectomy
• 2:34Laparoscopic myomectomy
• 3:40Abdominal myomectomy
• 4:23Hysterectomy
• 5:29Talking with your doctor

Full transcript

1. 0:03Introduction

   Hi, I'm Dr. Taz Varkey. Today I want to do my last video on uterine fibroids, and specifically I want to cover surgical management of uterine fibroids. In my last video I talked about non-surgical management options such as hormonal therapy and uterine artery embolization. Today I want to talk about the surgical options that include removing the fibroids or even perhaps removing the uterus.

2. 0:26

   So first let me talk about removing fibroids and the different methods by which we can do that. Set point, the first method, so basically removing the fibroids is a procedure known as myomectomy.

3. 0:45Hysteroscopic myomectomy

   Okay, and there's different ways we can do this. The first is hysteroscopically, and this is a procedure where we introduce a camera into the uterine cavity through the cervix.

4. 1:08

   So the woman's legs are in stirrups. We put a speculum in the vagina to open it up, and then we put a camera into the uterine cavity through the cervix. The patients are always under general anesthesia and out for this, so don't worry. But basically we put the camera in, and then through the camera there's ports where we can introduce blades, and we can shave out the fibroids that are located, I'll show you again this picture that I always draw, fibroids that are located in the uterine cavity here.

5. 1:30

   If this is the vagina, we'll be putting a camera in, and through this camera will be a blade that can kind of shave up this fibroid and suck it out, and that way we can remove these fibroids.

6. 1:54

   But this only works for fibroids that are actually involving the cavity. If we didn't have fibroids that are out here on the outer edge of the uterus or in the wall, we can't get to it using this camera or this approach known as hysteroscopy. So for those women whose symptoms may also include the size of the uterus, a large uterus pushing on other organs such as the bladder or the bowel, or pelvic pain or discomfort from the size of the uterus, for those women we actually have to remove enough fibroids to reduce the size of the whole uterus. So another way of performing a myomectomy is laparoscopic.

7. 2:34Laparoscopic myomectomy

   And laparoscopy, it's a procedure that is done by inserting a camera through the belly button and two or three smaller holes around the lower pelvis that are all usually less than a centimeter in size, and we can introduce instruments through those ports, and in that way these fibroids can be cut out and removed and the uterus sutured back up.

8. 2:56

   Now this procedure is a very specialized procedure and done by surgeons who have special training for that. Often they're known as minimally invasive surgeons. So it's a very specific skill set, but it is a nice less invasive way to get these fibroids up, if there are not too many of them and if they are located close enough to the outside that the surgeons can get in and remove them.

9. 3:18

   Okay, so if you've got a big fibroid down here, they may not be able to get it up to laparoscopy. And the last method would be an abdominal approach.

10. 3:40Abdominal myomectomy

    So abdominal myomectomy, and that's the procedure where we actually make an incision, often it looks like a C-section scar you might have seen, in the lower pelvis in the bikini line. It's usually about 6 centimeters long, sometimes bigger depending on how big the uterus is.

11. 4:03

    And sometimes that incision has to go up and down from the belly button down to the pubic bone if the uterus is very large with fibroids. But this is a procedure that we have to use if the surgeon hasn't been trained to do laparoscopic myomectomy, or if the fibroids are too big and too numerous to get out through a laparoscopic or a hysteroscopic approach.

12. 4:23Hysterectomy

    And then the other surgical option is known as hysterectomy, and hysterectomies also can be done through various approaches. Again, laparoscopically, it can be done through an open abdominal incision, and these can also be done a fourth way, vaginally.

13. 4:44

    So if the uterus isn't too big, the surgeon can make an incision, go through the vagina, and make an incision on the top of the vagina and pull the cervix and the uterus out that way.

14. 5:06

    So again, with hysterectomy, which is a removal of the whole uterus, that would be a hysterectomy, taking it all out, we could do it laparoscopically, abdominally, or vaginally. So which approach your surgeon chooses for you is going to depend on your symptoms, how many fibroids there are, how big they are.

15. 5:29Talking with your doctor

    So as always, it's important to have a discussion with your doctor about which approach is best for you. So that's it for today. Thanks for tuning in. I hope this was helpful, and please don't forget to subscribe. Thanks.