Can Large Uterine Fibroids Be Treated with Minimally Invasive Surgery? - Obstetrics and Gynecology

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When it comes to the treatment of large uterine fibroids, particularly those measuring around 15 centimeters, there are several options available, including minimally invasive surgery. However, the choice of treatment largely depends on the specific circumstances of the patient, including the size and location of the fibroids, symptoms experienced, and the patient's overall health and reproductive plans.

Minimally invasive surgery, such as laparoscopic myomectomy, is indeed a viable option for removing fibroids. This technique involves smaller incisions compared to traditional open surgery, which can lead to quicker recovery times, less postoperative pain, and reduced scarring. However, the feasibility of laparoscopic surgery for very large fibroids can be limited. Surgeons often assess the fibroid's size, location, and the patient's anatomy to determine if laparoscopic techniques can be safely employed. In some cases, if the fibroid is too large or if there are multiple fibroids, an open abdominal myomectomy may be recommended as it allows for better visualization and access to the fibroids.

Regarding the use of medication to shrink fibroids before surgery, this is a common approach. Medications such as GnRH agonists can temporarily reduce the size of fibroids by inducing a state similar to menopause, which decreases estrogen levels and can lead to a reduction in fibroid size. This can make the surgical procedure easier and potentially less risky. However, these medications are typically used for short periods due to their side effects and are not a long-term solution.

As for the concern about the potential malignancy of large fibroids, it is important to note that the vast majority of uterine fibroids are benign. However, any significant changes in size or characteristics of a fibroid, particularly in postmenopausal women, warrant further investigation to rule out the possibility of uterine sarcoma or other malignancies. Regular monitoring and imaging studies can help in assessing the nature of the fibroid.

Regarding the timeline before surgery, it is understandable to be concerned about the fibroid growing larger. Fibroids can indeed grow over time, especially if they are hormonally responsive. If surgery is scheduled in three weeks, it is advisable to maintain close communication with the healthcare provider to monitor any changes in symptoms or the size of the fibroid.

Choosing a surgeon with experience in performing myomectomies, particularly for large fibroids, is crucial. An experienced surgeon will be more adept at managing potential complications and ensuring the best possible outcome. It is also beneficial to discuss all concerns and preferences with the surgeon, including the surgical approach, recovery expectations, and any potential impacts on future fertility.

In summary, large uterine fibroids can be treated with minimally invasive surgery, but the decision should be made collaboratively with a healthcare provider who can assess the individual case. Medications may help reduce fibroid size prior to surgery, and selecting an experienced surgeon is essential for optimal outcomes. Always ensure to discuss all options, risks, and benefits with your healthcare provider to make an informed decision.