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What are the various laparoscopic methods to treat fibroids?

Q: In which cases is laproscopy preferred over an operation to remove the uterus, as in case of uterine fibroids. If a person is suffering from uterine fibroids as well as polyps at the mouth of the uterus, can laproscopy be done? Are uterine fibroids malignant? Is biopsy the only way to detect whether uterine fibroids are malignant?

A:Uterine fibroids (leiomyomas) are common noncancerous (benign) tumours of the uterus. They grow from the muscular wall of the uterus and are made up of muscle and fibrous tissue. Possibly as many as 80% of all women have uterine fibroids. While the majority usually have no symptoms, 1 in 4 end up with symptoms severe enough to require treatment. The diagnosis regarding benign/malignant can only be made after a histopathologic examination of the surgically removed tissue. Laparoscopic Myomectomy involves removing pedunculated subserosal fibroids through the navel and abdomen with the use of a laparoscope - a thin tube-like instrument with a light. Hysteroscopic Myomectomy involves the vaginal removal of submucosal fibroids through the use of a hysteroscope - a thin telescope-like instrument that is inserted through the cervix and into the uterus. Laparotomy (Abdominal Myomectomy) involves an abdominal incision that allows for the removal of all fibroids no matter their location, size, or number. Laparoscopic Myomectomy with Mini-Laparotomy allows for the removal of slightly larger subserosal fibroids than what the laparoscope alone can handle and generally includes a relatively small incision of 3 inches or less in the abdomen. Laparoscopic Assisted Vaginal Myomectomy allows for the laparoscopic removal of subserosal fibroids from the uterus with the total removal of fibroid material through a vaginal incision. Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) are the easiest to remove laparoscopically. Many subserous myomas (close to the outer surface) can also be removed through the laparoscope. Fibroids that are deep in the wall of the uterus, or submucous are most difficult to remove laparoscopically. The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. One concern when there are multiple fibroids is of leaving smaller myomas behind. Often it is necessary to feel the uterus to find the smaller myomas; these likely would be left behind during a laparoscopic myomectomy. When there are deep myomas and a large number of myomas, it is possible to repair the uterus better by doing an abdominal myomectomy.


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