How to perform uterine fibroid surgery

The main surgical methods for uterine fibroids include laparoscopic surgery, hysteroscopic surgery, open surgery, focused ultrasound ablation surgery, vaginal surgery, etc. The choice of surgical method for uterine fibroids needs to be comprehensively evaluated based on factors such as the size, location, and number of fibroids and the patient’s fertility needs.

1. Laparoscopic surgery

Laparoscopic surgery is suitable for patients with fibroids less than 10 cm in diameter and a small number of patients. This surgery is completed by inserting instruments through a small incision in the abdomen, with less trauma and faster recovery. You may experience mild abdominal distension or shoulder radiating pain after surgery, which usually resolves within 1-2 weeks. For those who want to have children, attention should be paid to avoid excessive electrocoagulation damage to the endometrium during the operation.

2. Hysteroscopic surgery

Hysteroscopic surgery mainly targets submucosal fibroids or intramural fibroids that protrude into the uterine cavity. The uterine cavity is entered through the natural orifice to remove the fibroids without any incision on the body surface. You may experience transient vaginal bleeding or cramping pain in the uterus after surgery. This surgery can restore the shape of the uterine cavity better and is suitable for patients with fertility needs. However, attention should be paid to the prevention of intraoperative perfusion fluid absorption syndrome.

3. Laparotomy

Laparotomy is suitable for cases where the fibroids are huge, numerous or suspected of malignant transformation. Fibroids or uterus are removed directly through an abdominal incision with clear vision and thorough operation. You will need to stay in the hospital for 5-7 days after surgery, and the recovery period will be longer, and incision pain or intestinal adhesions may occur. For patients with multiple fibroids who do not need to have children, hysterectomy may be considered to reduce the probability of recurrence.

4. Focused ultrasound ablation

Focused ultrasound ablation is a non-invasive treatment that uses focused ultrasonic waves outside the body to produce thermal energy to ablate fibroids. It is suitable for patients who are unwilling to undergo surgery or who wish to preserve the uterus, but strict screening of indications is required. After treatment, there may be dull pain in the lower abdomen or an increase in vaginal secretions. Usually, the size of the fibroids will gradually shrink after 3-6 months. This method has limited effect on pedunculated submucosal fibroids.

5. Vaginal surgery

Vaginal surgery is the transvaginal removal of fibroids or uterus, and is suitable for patients with good uterine mobility and low-lying fibroids. There is no incision on the body surface but the surgical field of view is limited, and the postoperative recovery is faster. There may be temporary difficulty urinating or bleeding from the vaginal stump. This surgery has high technical requirements for the surgeon, and it is necessary to evaluate the looseness of the vagina and the accessibility of fibroids.

The perineum should be kept clean after surgery, and heavy physical labor and sexual life should be avoided for 2 months. Pay attention to supplementing your diet with high-quality protein such as fish and soy products, and eat an appropriate amount of iron-containing foods to prevent anemia. Regularly review the ultrasound to observe the recovery. If fever, abnormal bleeding or persistent abdominal pain occurs, seek medical attention promptly. Different surgical methods have their own advantages and disadvantages. It is recommended to choose an individualized plan after full communication with the attending doctor.