Can I have minimally invasive surgery for giant fibroids?
The answer is yes. Let’s look at the following case of a patient.
In late October 2013, we admitted a woman named Du. On admission, the uterus was found to be as large as 4 months of pregnancy, hard and poorly mobile. Ultrasound showed an enlarged uterus with abnormal echogenicity (98mm×78mm, considered myoma) and visible blood flow signal. The diagnosis of giant uterine fibroid was made on admission. The uterus was enlarged as in the fourth month of pregnancy, and a myoma nodule of about 9cm×8cm protruded from the posterior wall. The postoperative pathology was reported as uterine smooth muscle tumor. The patient recovered and was discharged 3 days after surgery. Han Liping, Department of Obstetrics and Gynecology, First Affiliated Hospital of Zhengzhou University
Uterine leiomyoma, also known as uterine smooth muscle tumor, is one of the most common benign tumors of the female genitalia. It is mostly asymptomatic, with a few manifestations such as vaginal bleeding, abdominal masses and pressure symptoms. It may cause pain in case of torsion or other conditions. Uterine fibroids can be divided into subplasma fibroids, interstitial fibroids, submucosal fibroids or cervical fibroids, broad ligament fibroids, etc. About 20% of women over 35 years old have uterine fibroids, and multiple fibroids are common. The number of uterine fibroids is more than 2, which is called “multiple fibroids”, and the diameter is more than 5cm, which is called “giant fibroids”. Uterine fibroids are hormone-dependent tumors, but their development is the result of a combination of factors. For patients with giant fibroids, the main treatment options are surgery. If a single fibroid is more than 5.0 cm and has an abundant blood supply, it should be operated as soon as possible if it grows rapidly in a short period of time. Professor Lang Jinghe, a renowned obstetrician and gynecologist and director of the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, pointed out that fibroids are benign tumors, but there is a potential risk of malignant transformation if they grow too fast. Therefore, women of childbearing age must have regular checkups and listen to their doctors once they are diagnosed, not to listen to prescriptions or make their own decisions, and not to refuse surgery out of fear, so as not to “feed” the tumor as a problem.
The laparoscopic surgery has the advantages of less trauma, faster recovery, less complications and enlarged surgical field and clear images compared to the traditional open surgery. However, huge fibroids increase the difficulty and risk of surgery, and the most critical aspect of surgery is the surgeon’s skillful and solid laparoscopic techniques and microscopic suturing skills. Therefore, for gynecologists who are familiar with local anatomy, familiar with laparoscopic operating techniques, have basic skills to deal with emergencies and a solid foundation of open abdomen, laparoscopic giant uterine fibroid removal is feasible and can give full play to the advantages of laparoscopic surgery and will become the choice of patients. (Han Liping, Hu Qinghong)