January 16, 2016
Dr. Prabha Manchanda
Dr. Rahul Manchanda
Dr. Vijay Patil
This young unmarried girl with a fibroid came from Aligarh. She was sent by an interventional radiologist colleague who thought she needed a myomectomy, and rightly so.
Presenting with nothing but an abdominal mass.
Ultrasound showed multiple (around 8 myomas) of sizes ranging from 1to12 cm.
An abdominal examination revealed a 32-week pregnancy sized uterus.
With adequate consent and preparation she was taken up for a laparoscopic myomectomy.
The big fibroids were removed laparoscopically, beginning at the top. But as we kept going down, more and more fibroids started to appear and it was considered in the best interest of the patient to convert to a laparotomy for a more complete removal of even the smaller fibroids keeping in view her marital status and impending marriage.
Eventually a total of 18 fibroids of sizes ranging from 1-15cm were removed.
Traditional text books mention more than two myomas if present then laparotomy should be preferred over laparoscopically. We find this incorrect and has been proved time and again by us and various other laparoscopic surgeons.
We feel it really is the skill of the surgeon that governs the choice of surgical route as in any surgery.
And one should make a decision on what surgery keeping in mind the patients safety at all times.
Size of fibroid: larger the fibroid the more difficult it is, but if single can be easily removed.
No. of fibroids: more the no.of fibroids , the more difficult it is to do laparoscopically. Indeed this is more important a point in selection of the route of surgery than size. Single large fibroids of any size can be removed easily with skill, rather than multiple fibroids distorting the uterus.
Soft and vascular fibroids: more difficult to get a grip on and dissect out.
Comment : We have succeeded in taking out very large tumors also laparoscopically but One should never be dogmatic or fastidious and the patients well being must always be our first priority even while deciding to convert to an open surgery.