Laparoscopic Myomectomy: A Safe and Effective Procedure in Multiple Submucosal Fibroids
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2017, Vol 1, Issue 1
Abstract
We report a case of 31 year old nulligravida with multiple sub mucosal and intramural fibroid uteri which was managed by laparoscopic myomectomy. She was asymptomatic and was diagnosed with multiple fibroid uterus and primary infertility. She and her partner were evaluated completely for other causes of infertility and all investigations were normal. She was further evaluated with mapping of myomas on Magnetic resonance imaging and underwent laparoscopic removal of all 10 fibroids in the same sitting. In this case report, we highlight the advantage and the technical challenges in laparoscopic removal of multiple sub mucosal fibroids in the same sitting that overcomes the complications encountered during hysteroscopic removal of multiple fibroids. Fibroids are the most common benign gynaecological tumour that affects reproductive aged women with a prevalence of 20- 50% among them [1]. In general, uterine myomas are found in 5% to 10% of women with infertility. In 1.0% to 2.4% of women with infertility, myomas are the only abnormal findings [2,3]. Submucous myomas account for 5.5 % to 10 % of all uterine myomas [4]. Submucous myoma can be symptomatic irrespective of their size. They cause menorrhagia that can lead to anemia, infertility [5,6]. The route of surgery employed depends on the size, number and location of fibroid. Hysteroscopic resection of the myoma is the gold standard in selected patients with sub mucous fibroids (type 0,1,2). However, in women with associated subserosal and intramural fibroids, multiple sub mucosal fibroids with deep intramural extension(type1-5,2-5), sub mucosal fibroids more than 5 cm in size, laparoscopic route is the appropriate choice [7,8]. Hysteroscopic myomectomy has its associated complications of uterine perforation, fluid overload, uterine bleeding if performed by an inexperienced surgeon. Prolonged hysteroscopic surgery can lead to fluid overload and consequent electrolyte imbalance. In general, sub mucous myomas up to 4 to 5 cm can be resected hysteroscopically by an experienced surgeon but women with larger myomas and multiple myomas (>2 in number) benefit from laparoscopic surgery [8]. We report a 31year old nulligravida who presented to.com with a diagnosis of multiple fibroid uterus when she was being evaluated for primary infertility. She has been married for 2 years. Her menstrual history is regular with no complaints of menorrhagia or dysmenorrhoea. She is a known hypothyroid on supplementation with thyroxin 25 mcg. No history of other associated medical co morbidities. There was no history of previous surgery. On clinical examination, the uterus was of 22 weeks size, irregularly enlarged, fibroid was palpable in right lateral, posterior fornices with restricted mobility. She was further evaluated with a Magnetic resonance imaging (MRI) mapping of the myomas which was suggestive of multiple fibroids, 10 in total. Five sub mucosal fibroids, two fibroids were intramural in location and three of them were subserosal. Both the ovaries were normal on MRI.
Authors and Affiliations
Kavitha Yogini Duraisamy, Devi Balasubramaniam, Amrutha Kakollu, Kodeeswari Periyasamy, Palanivelu Chinnusamy
Keywords
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- EP ID EP569082
- DOI 10.32474/IGWHC.2018.01.000105
- Views 94
- Downloads 0
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