Myomectomy plus a Hysteroscopic Myomectomy of a patient with multiple fibroids

in Max Super Speciality Hospital, Mohali

Apr 18 , 2023

A 36-year-old woman patient came to the OPD at Max Super Speciality Hospital, Mohali, with complaints of two previous miscarriages and a wish to conceive. She was obese, with a BMI of 30.

As part of the pre-operative evaluation, an ultrasound was suggested, which revealed multiple intramural, Sub mucosal and Sub serosal fibroids scattered in the uterine musculature.

After the initial evaluation and pre - anaesthetic work-up, the patient was suggested a combined Robotic-assisted Myomectomy plus a Hysteroscopy Myomectomy.

With the precise robotic dissection, 13 fibroids were removed, both large and small. This created a space in the uterus so that the patient could conceive in the near future. The patient was discharged in satisfactory condition, and she is in regular follow-up.

In such cases, the fibroids could have been retrieved from the keyhole incisions with ease, after the coring technique of manual Morcellation, but with the robot, it was possible to visualise and remove even the smallest fibroids (magnification of the robot is more than that of laparoscopy) which were embedded deep in the myometrium. The doctors gave a minimal number of incisions on the uterus so that the reconstruction of the uterus could be done easily.

The tunnelling technique was used to remove these soft tissue tumours. Since the patient expressed her wish to conceive, robotic surgery had the added advantage of precise dissection with minimal tissue injury and minimal to nil blood loss.