When to go for surgical removal of Uterine Fibroids? - Dr. Shanthala Thupanna

Surgically removal of the fibroids will be done only in the patients who are symptomatic. The type of the surgery depends on the age of the patient and if the patient has completed her family. If the patient has completed her family and she is 40 plus, we give an option of taking out the uterus also. If the patient is young, the better option is to go for the removal of the fibroid that is the myomectomy. Only the symptomatic fibroids are removed. The asymptomatic fibroid, no need for removal at all. Just observe the fibroid over a period of years and hence we do the scanning every 6 months, will be more than sufficient. If the size is becoming small or the patient is having the symptoms, we can plan for the surgery later on. If the patient is having symptoms, they can undergo laparoscopic surgery or open surgery. Laparoscopy has an advantage where we make the small cuts, less pain, better vision with the laparoscopy. Obviously laparoscopy is better for any kind of surgery, whether it is fibroid removal or uterus removal. Hysteroscopy is one more option of removal of the fibroid. Hysteroscopy is done when the fibroid is projecting in to the uterine cavity and when there is a small fibroid, we put a small camera into the uterus and we shave the fibroid till the base is taken out. Those kinds of fibroids will present with heavy bleeding. So in those cases, no need to do surgery from the abdomen side, we can take through the hysteroscopy. That we call as the hysteroscopic fibroid resection. Previously we used to think that bigger the fibroid, difficult to do the laparoscopic surgery. We have to do the open surgery. If the surgeon is very well experienced, then the laparoscopy is good for the fibroid removal. One more doubt these days is if the fibroid is cancerous in nature, is it safe to do laparoscopy in those kind of patient. Most of the cases, when ere is a rapidly growing fibroid, when the age is more, the size is increasing, we can do an MRI scan, we can check if there is any probability of cancer in the fibroid. In such cases, we can avoid the laparoscopic surgery. We can do an open surgery for those cases. Nowadays one more case of suspicion, we have a morsafe bag, where we put after the surgical removal of the fibroid, we do laparoscopy and we put into the bag, we remove through a morcellator, that is morsafe bag, where the spillage can be avoided. Through that we can take the fibroid from the abdomen. The advantages are more with a laparoscopic surgery compared to the open surgery. So in fibroid removal, we stich the uterus like we stich in a caesarian section. So it will take 4 -6 weeks for the uterus healing. Later they can conceive posts surgery. When we have an elderly patient, when they have completed the family, uterus removal surgery is opted.