Uterine fibroid is the most common benign tumor that develops in the muscular layer of the uterus. The onset and development of uterine fibroids occurs during a woman’s reproductive period, with significantly elevated hormone levels during this period contributing to their growth.
Approximately 40% of women over the age of 35 are diagnosed with uterine fibroids. In most cases there are several fibroid nodules in the uterus, ranging in size from a few millimetres to impressive dimensions when their increased number and size can reach the size of a full-term pregnancy.
The location of the fibroid nodules and especially their relationship with the uterine cavity is responsible for the problems the patient suffers from – pain, heavy menstrual bleeding.
What are the modern techniques for removing fibroid nodules?
Myomectomy is the surgical procedure to remove uterine fibroids (myomas). Unlike hysterectomy, which removes the entire uterus, myomectomy removes only the fibroids and leaves the uterus intact. Most fibroids are harmless, often asymptomatic. When they become troublesome, enlarging in size, pressing on surrounding organs, causing pain or occasionally bleeding, sometimes causing complications, surgical excision should be considered.
Surgical treatment is indicated in the following situations:
- heavy uterine bleeding, with a high risk of causing anaemia or pregnancy complications;
- in case of a history of miscarriages, when the fibroid is assessed as causing or preventing the onset/appearance of pregnancy;
- when it presses/deforms uterine structures or causes pressure on surrounding organs (bladder, ureter, intestines)
- when assessing the risk of malignancy
- when the pain caused affects the patient’s quality of life.
Depending on these criteria, on the severity of the symptoms, on the clinical picture as a whole, on the implications that the intervention will have on the woman’s reproductive capacity or possible complications for a pregnancy, for example, the gynaecologist will assess whether to resort a myomectomy or a radical hysterectomy.
Robotic myomectomy – the most advanced technique used in the removal of uterine fibroids
Today, myomectomy surgery is performed minimally invasively, with robotic surgery being the most advanced technique to remove multiple, large fibroids, a more precise, safer way, with minimized risks and bleeding during the procedure, with major benefits for patients who need this intervention.
About a complex myomectomy procedure performed by the team led by Prof. Dr. Elvira Bratila using the da Vinci robotic platform:
“What was interesting in the robotic approach to the intervention in a patient who had no less than 13 fibroids, the largest of which was 8 cm in size, was to intervene in the uterine cavity with millimetric precision and with the certainty that you will not damage or obstruct the uterine structures. The Da Vinci XI platform allowed us to perform transvaginal intraoperative ultrasound so that we could perform excision of all fibroid nodules, which were significantly affecting the intrauterine cavity. During the operation, losing 300 ml of blood was more than reasonable! .”
Robotic surgery benefits for the patients:
- The minimally invasive approach through robotic surgery is the best choice for the patient, requiring hospitalization for a short period 2 days and rapid recovery of the patient.
- Robotic surgery is undoubtedly a step forward also in the surgical treatment of uterine fibroids, especially difficult cases in patients with associated comorbidities such as morbid obesity.
- Minimal trauma, risk of bleeding and reduced complications mean rapid recovery for patients.
- Reduced hospitalization and recovery time.
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