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Laparoscopic Procedures
  Total Laparoscopic Hysterectomy
Supracervical Hysterectomy
Myomectomy
Excision of Endometriosis
Laparoscopic Uterine Suspension
Oophorectomy
Cystectomy
 
Urogynecology Procedures
  Bladder Slings (TOT & TVT slings)
Laparoscopic Sacral Colpopexy
Cystocele Repair (Bladder repair)
Rectocele Repair
Vaginal Vault Suspension-Uterosacral liga
Vaginal Vault Suspension-Sacrospinous liga
Colpocleisis
Graft Augmentation (Biologic and Synthetic Mesh)
 
Patient Education
  Interstitial Cystitis
Pelvic Organ Prolapse
Recurrent Bladder Infections
Urinary Incontinence
 
Myomectomy
Uterine fibroids are the most common benign tumors found in the female reproductive tract. They are composed of muscle cells similar to the cells that make up the uterus. They can vary in size from a small pea to a large melon. Fibroid symptoms can range from being asymptomatic (no symptoms) to pelvic pressure and pain and heavy frequent periods. A fibroid uterus is the most common reason for hysterectomy in the United States (account for 30% of all hysterectomy in the U.S.). Most women who have symptoms from their fibroids have hysterectomies performed. However, women who are young, and who would like to preserve fertility have the option of Myomectomy. Myomectomy is a surgical procedure that removes the fibroids from the uterus while keeping the uterus intact.

Because of high rate of recurrence, Myomectomy is generally not recommended for women who have completed child bearing yet continue to suffer from excessive heavy menstrual periods, pelvic pressure and pain due to fibroids. Traditionally a large abdominal incision is required for this procedure but as laparoscopic surgeons have refined their skills over the past 15 years, laparoscopic myomectomy has become a better alternative in the hands of experienced laparoscopic surgeons.

Frequently asked questions about uterine fibroids:

What are the advantages of having laparoscopic myomectomy?

Laparoscopic myomectomy is removing the fibroids by using laparoscopic surgical technique. Laparoscopic surgery is a minimally invasive procedure, usually performed as outpatient surgery under general anesthesia. It has revolutionized gynecological surgery because of short hospital stay, better cosmetic appearance, and quick recovery. In laparoscopic surgery, surgeons are using electronic eyes (a very sensitive video camera) instead of our own eyes to do surgery. With a very bright light from laparoscope directly shinning over the surgical field, the operative site is magnified with higher resolution on TV monitors through the video camera. With better visibility of the operative field, surgeon can identify and dissect within the right surgical planes more precisely and easily, thus avoiding unnecessary tissue trauma and greatly reduce the blood loss during surgery.

 
Because the incisions are small, recuperation is usually associated with minimal discomfort. Since the abdominal cavity is not opened, bacterial contamination is minimized, and the risk of infection is low. The intestines are not exposed to the drying effect of air or the irritating effects of the sterile gauze pads used to hold the bowel out of the way during the abdominal surgery. As a result, the normal bowel function returns almost immediately after the surgery. This not only spares the patient with postoperative gas pain, it also avoid days of delay before a person is able to eat following traditional abdominal surgery. After laparoscopic myomectomy, women usually return to normal activity, work and exercise within 7-10 days.

As stated previously that laparoscopic myomectomy is technically more difficult than the traditional open surgery, your gynecologist should have the extra training and experience that it requires. Otherwise, the risks involve with laparoscopic myomectomy performed by an inexperienced surgeon will most likely overweigh the advantages stated above.

What causes fibroids?

While there is much we don't know what causes fibroids exactly, we believe that there is probably has something to do with genetic or cell mutation. Under some complex factors, (environmental, hormonal, and/or aging) that prompt certain individual cells start to grow the wrong way. There are strong evidences showing that female hormones (estrogen and progesterone) are necessary for the fibroid to grow. Fibroids do not grow until after puberty and if a woman has a fibroid uterus, the fibroids will shrink after the menopause, when the production of female hormones ceases.

Does uterine fibroids relate to fibrocystic change of breasts?

No, they are totally different and unrelated condition. When a woman has fibroids, she is not more prone to develop any other benign or cancerous condition in her body.

Can fibroids cause infertility?

Fibroids are not usually a cause of infertility. In order to cause infertility, the fibroids must be growing very close to and actually obstructing the uterine openings of the Fallopian tubes, and block the passage of the egg as it enters the uterus. Both tubes must be blocked, since only one open tube is needed for pregnancy to occur.

Can fibroids be treated with medications?

There are several medications marketed to control the symptoms of fibroids. Unfortunately, there are no medications that can permanently shrink the fibroids once they are present. Medications can temporarily reduce the size of the majority of fibroids and decrease the amount of menstrual bleeding. This allows some women to take their time to prepare physically and emotionally for surgery. Lupron and Synarel are most commonly used to shrink fibroids at present. They work by temporarily shutting off the ovary to produce female hormones and stop the menstrual periods. In about two weeks the medications begin to shrink the fibroids and the full effect is seen after three months. About 75% of treated fibroids will decrease in size by about 50% in three months. The shrinking effect of the fibroids is maintained as long as the patient is using medication, but there is rarely any further shrinkage after the third month of treatment. Unfortunately, if the medication is stopped, the ovaries begin to produce female hormones again and fibroids usually return to their original size within three months. The main side effects of Lupron and Synarel are producing menopausal symptoms and risk of significant bone loss (osteoporosis) if used for more than six months.

Can Fibroids turn into cancerous if untreated?

Uterine cancer caused by fibroids is extremely rare and it usually occurs after patient going to menopausal in their fifties and sixties. The majority of premenopausal women with growing fibroids have benign uterine fibroids. However, if a patient is postmenopausal and does not take estrogen, any growth of the uterus is an indication for surgery.

What is uterine artery embolization procedure for the treatment of fibroids?

Uterine artery embolization is a procedure that shrinks fibroids without surgical removal of them. The procedure is performed by the interventional radiologist by injecting the embolizing agent to both uterine arteries (blocking the main blood supply to the uterus), producing temporal ischemic change (low blood flow, thus low oxygen saturation) to the entire uterus, including fibroids, causing the degeneration (death) of the fibroids. Compare to the normal uterine cells, fibroid cells are much more sensitive to low oxygen saturation and they will die very quickly in low oxygen environment. When the main blood supply to the uterus is diminished greatly by blocking both uterine arteries with embolizing agent, the normal uterine tissue will continue to survive but not the fibroids, they would die and eventually will be absorbed by the uterus. The problem is when patient has large volume of degenerated (dead) fibroid tissue within the uterus, it can cause certain problems for patient, some degree of swollen in the lower abdomen and most of patients will experience fever, malaise, pain (sometime can be severe) and discomfort. Because of the potential risk of damaging to the endometrium (lining of the uterine cavity) and possible uterine rupture during labor, we do not recommend the uterine artery embolization procedure if you desire future fertility.

 

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