What are the steps of a laparotomy (surgical incision into the abdominal cavity) myomectomy (removal of uterine fibroids) procedure?

From the Guidelines

When explaining laparotomy myomectomy to a patient, I would describe it as a surgical procedure to remove uterine fibroids through an abdominal incision, emphasizing the potential benefits and risks, including symptom relief and the possibility of future complications, as noted in studies such as 1. The procedure involves several key steps, including:

• General anesthesia to ensure patient comfort during the surgery
• An incision in the lower abdomen, which can be either horizontal or vertical depending on the size and location of the fibroids
• Careful removal of each fibroid from the uterine wall, followed by repair of the uterine muscle and closure of the incision layers
• A hospital stay of 2-3 days, followed by 4-6 weeks of gradually increasing activity at home
• Management of post-operative pain with medications, as well as potential vaginal bleeding and temporary fatigue It's essential to discuss the potential benefits of laparotomy myomectomy, including symptom relief from heavy bleeding, pelvic pain, or pressure, while also noting the risks, such as bleeding, infection, damage to surrounding organs, adhesion formation, and the possibility of future cesarean delivery if pregnancy occurs, as highlighted in the study by 1. The patient should be informed that this surgery is recommended for women with symptomatic fibroids who wish to preserve fertility, as it maintains the uterus unlike hysterectomy, and that the recurrence rate ranges from 23% to 33% [as noted in 1]. Key points to emphasize include:
• The importance of carefully weighing the potential benefits and risks of the procedure
• The need for close follow-up care to monitor for potential complications
• The possibility of future interventions, such as additional surgery or other treatments, if symptoms recur or persist
• The importance of discussing individual circumstances and medical history with a healthcare provider to determine the best course of treatment, as supported by the study 1.

From the Research

Explaining Laparotomy Myomectomy to Patients

To explain the steps of a laparotomy myomectomy procedure to a patient, consider the following points:

• Laparotomy myomectomy is a surgical procedure used to remove uterine fibroids while preserving the uterus 2.
• The procedure involves making an incision in the abdomen to access the uterus and remove the fibroids 3, 2.
• The steps of the procedure may vary depending on the surgeon and the individual case, but generally include:
  • Preparation and selection of the patient, including prehabilitation and cartography of the myoma(s) 4.
  • Making an incision in the abdomen and accessing the uterus.
  • Removing the fibroids, which may involve enucleation, dissection, and traction 4.
  • Controlling bleeding and achieving hemostasis, which may involve techniques such as temporary uterine artery occlusion or utero-ovarian vessel occlusion 5.
  • Closing the incision and completing the procedure.

Benefits and Risks

It's also important to discuss the benefits and risks of laparotomy myomectomy with the patient, including:

• The potential benefits of preserving fertility and alleviating symptoms such as heavy menstrual bleeding and pelvic pressure 3, 2.
• The potential risks and complications, such as bleeding, infection, and adhesions 3, 5.
• The alternative treatment options, such as uterine-artery embolization or hysterectomy, and the potential advantages and disadvantages of each 3, 6.

Surgical Approaches

Laparotomy myomectomy is just one of several surgical approaches that may be used to treat uterine fibroids, including:

• Laparoscopic myomectomy, which involves making small incisions in the abdomen and using a laparoscope to visualize the uterus 4, 6.
• Robotic myomectomy, which involves using a robotic system to assist with the procedure 6.
• Hysteroscopic myomectomy, which involves making no incisions and using a hysteroscope to visualize the uterus and remove fibroids 2, 6.
• Mini-laparotomy, which involves making a smaller incision than traditional laparotomy and may be used as an alternative to minimally invasive approaches 6.