What are fibroids?
Fibroids are the commonest non-cancerous tumors present in the female genital tract.Fibroids are believed to arise from a single muscular fiber. They are present in 80% of menstruating women though only about 10% of them cause problems.
Why does one get fibroids?
Several factors have a key role in formation of fibroids. Genetic factors coupled with hormonal imbalances are commonly blamed. Few of the other risk factors include ethnicity (African women), nulliparous women, central obesity, etc.
What are the issues caused by fibroids?
- Heavy menstruation with passage of clots
- Pelvic pain and discomfort
- Frequent urination
- Severe back pain
What happens if I do not have any symptoms due to my fibroid(s)?
We suggest a 6-monthly follow-up of the fibroids (using ultrasound scan) to check the size of the fibroid. If the fibroid gets larger than 6 cm, undergoes twisting , grows rapidly or undergoes degenerative changes further investigation and treatments are necessary.
How can we diagnose fibroids?
A basic history with physical examination, a trans vaginal ultrasound, CT , MRI or a hysteroscopy can diagnose the number and size of fibroids.
What are the types of fibroids?
Based on their location they are classified as
There are other variations based on their position on the uterus like cervical fibroid, broad ligament fibroid, etc.
Are fibroids cancerous?
Thankfully only a very small percentage of fibroids (<1%) undergo cancerous changes. For this reason, we at Indigo Womens Center take precautions like in-bag morcellation for high risk patients undergoing surgery. This is a novel technique where the fibroid is placed inside a bag and then cut into tiny pieces, avoiding spillage of fibroid bits inside the abdomen.
What are the treatment options for fibroids?
Some of the medical management include oral contraceptive pills, Intrauterine devices, progestins, GnRH analogues, SERM, etc.
They help reduce the size of the fibroids.Patients who cannot undergo surgery or close to menopause are good candidates for medical management.
Medical management cannot be used in situations where the patients are looking to conceive.
Can we remove fibroids completely?
The only way to completely remove a fibroid is by performing a fertility preserving laparoscopic myomectomy. This is a fairly advanced procedure that requires immense skill and suturing expertise to adequately restore the uterine anatomy.
Laparoscopic myomectomy is considered as a gold standard treatment for fibroids.
Are there any alternatives to surgery?
Several new techniques like high frequency focused ultrasound (hiFU), MRgFUS and Uterine Artery Embolization (UAE) have been tried. Unfortunately, they have a negative effect on the ovarian function and fertility, thus the purpose of trying to preserve the uterus is lost. For this very reason these newer modalities are not gaining much traction.
At Indigo Womens Center we take every effort to make your procedure as “pain-less” and “scar-less” as possible. Dr. Surakshith Battina is a high-volume surgeon and is specifically trained in advanced gynecologic laparoscopic procedures. We can deliver the highest level of skill with new and innovative techniques to simplify even the most complex procedures and ensure the least pain during recovery.
For procedural videos click here.
Why is uterine artery ligation important?
Uterine artery carries blood to the uterus, it also carries blood to the fibroid. By temporarily clamping the uterine artery, we are cutting out the blood supply to the fibroid during surgery. This prevents excessive blood loss during surgery so a blood transfusion won’t be necessary. Various studies proved that uterine artery ligation did not change the fertility potential of the individual.
Does myomectomy improve fertility?
Fibroids within the uterine cavity obstruct fertilization, sometimes even cause premature birth. Fibroids present towards the corneal end of the uterus might block the passage of the egg through the fallopian tubes. Myomectomy greatly enhances the chances of conceiving.
How does intracorporal suturing reduce anesthesia risks?
The fibroid occupies a large space within the uterus.This cavity needs to be closed using intracorporal suturing. Due to our high case volume, we are able to close the uterine cavity much more efficiently and greatly reducing the time of anaesthesia.
What is power morcellation and why has FDA banned it?
Morcellation is a process of removing large fibroid mass using a motorised morcellator. Morcellating a fibroid in patients who have a very rare form of fibroid cancer may pose a chance of spreading the cancer to a higher stage due to spread of the tiny fibroid pieces (dissemination) .Due to the sensationalisation in the news about one patient who had an upstaging of her cancer after morcellation , the FDA had to take a hasty decision regarding the issue.
Advantages of a laparoscopic myomectomy at Indigo Womens Center:
We perform laparoscopic myomectomies using highly advanced energy sources and we are specialists in endo-suturing techniques. In contrast, a general ob gyn might resort to basic electric cautery (and scissors) and inadequate suturing.By our advanced techniques we are effectively reducing the time of anaesthesia and time of surgery.
The patient will be able to get back to her family and loved ones the very same day. Our surgical team is extremely efficient and we perform surgeries within the shortest time due to our high case volume, this way we are able to give you a speedy recovery.
There will be minimum blood loss during surgery because we temporarily ligate the uterine artery before proceeding with myomectomy. This innovative technique is rarely performed elsewhere because most gynaecs lack the knowledge of pelvic anatomy and understanding of laparoscopic ergonomics.
The patient will have the least pain post-surgery due to our time efficiency and our innovative techniques. Our anesthesia team are specifically trained in post-surgical analgesia.
We perform the procedure using the least number of ports in the abdomen, this way we ensure your surgery has minimum number of scars. For instance, most surgeons preform diagnostic procedures with three ports in the abdomen whereas we can perform the same procedure only using two ports.
Patients with severe adhesions behind the uterus due to endometriosis or previous surgery, we perform retroperitoneal dissection to identify the ureters and separate them away from the surgical area. Very few ob gyn specialists are able to perform this dissection because it requires years of experience and good understanding of instrument ergonomics and anatomy to perform safely.
We have no limitation to the number of fibroids or the size of fibroids which can be removed from the uterus. Most ob gyns may resort to open myomectomy or robotic myomectomy if there are more than 10 fibroids or fibroids larger than 15 cm. Our surgical volume has given us the surgical experience to tackle any complication laparoscopically, this gives us the confidence to perform all surgeries via laparoscopy regardless of size or number of fibroids.