Rise of robotics
How robotics is changing the face of gynaecological surgery. By Denis Tsepov
LEAPs
Robotic surgery for uterine fibroids
What are uterine fibroids?
Fibroids are typically benign (non-cancerous or pre-cancerous) uterine tumours. However, in extremely rare cases, they can become malignant.
Many women will be diagnosed with uterine fibroids at some point in their lives. Very often fibroids are found during an unrelated pelvic examination or a gynaecological ultrasound. Oestrogen and progesterone appear to play a part in the growth of uterine fibroids and, for that very reason, fibroids typically reduce in size after menopause when oestrogen and progesterone production decreases.
Fibroids vary in size from very small to large tumours that can distort and enlarge the uterus, affecting its function and that of other pelvic and abdominal organs. They can be solitary or multiple and can grow inside the uterine muscle (intramural), into the uterine cavity (submucosal) or outside the uterus (subserosal).
What symptoms do fibroids cause?
Many women who have fibroids don't have any symptoms at all. For those who do, these symptoms can vary depending on the location of fibroids, their size, and number.
The common symptoms of uterine fibroids are:
- Heavy periods
- Prolonged periods
- Anaemia caused by heavy menstrual bleeding
- Chronic fatigue
- Inter-menstrual bleeding / unscheduled vaginal bleeding
- Pelvic pressure symptoms, palpable abdominal mass
- Pelvic pain
- Difficulty getting pregnant or carrying a pregnancy
- Frequent urination
- Difficulty emptying the bladder
- Difficulty emptying the bowel
- Back pain or leg aches
- Acute severe pelvic pains associated with interruption of a blood supply to a fibroid
Am I at extra risk of developing uterine fibroids?
Fibroids can run in families and occur in all ethnic groups, however black women are at more increased risk of developing uterine fibroids and can have more severe symptoms. Other factors that can increase risk include the early start of menstruation, vitamin D deficiency, excessive alcohol intake, and excessive weight.
Pregnancy and fibroids
Fibroids can sometimes interfere with fertility and a woman’s ability to carry a pregnancy, especially if they distort the uterine cavity. Fibroids may also increase the risk of complications in pregnancy or delivery, and the chances of delivery by caesarean section.
Advanced diagnosis and treatment
At London Endometriosis & Advanced Pelvic Surgery, we offer rapid and efficient diagnosis of uterine fibroids, using high-definition ultrasound scans and MRI scans, performed by our highly specialised radiology team. After the diagnosis is made, our gynaecology team will discuss your treatment options with you. This can range from conservative fertility-sparing surgery to more radical surgical treatment such as hysterectomy. This discussion will take into account your individual circumstances, fertility aspirations, needs and preferences.
Fertility-preserving surgery
We offer various fertility-sparing treatments for fibroids, including robotic keyhole myomectomy or, in case of submucosal fibroids, hysteroscopic trans-cervical fibroid resection (TCRF), a procedure performed vaginally and which doesn’t require any cuts in the abdominal wall.
Robotic-assisted myomectomy
During this procedure, we remove the fibroids by robotic-assisted keyhole surgery either vaginally or via a small 3-5 cm cut in the lower abdomen at the “bikini line” or in the umbilical area. We then carefully repair the uterus in layers using dissolvable sutures to ensure optimal healing.
Robot-assisted laparoscopic myomectomy is similar to a laparoscopic myomectomy, but advanced technology allows us to use natural wrist movements to control a sophisticated system of robotic surgical tools from outside the body, while viewing the whole operation in 3D.
To ensure optimal strength and allow the uterine scar to fully heal, we recommend waiting six months after surgery before trying to get pregnant. Post-surgery, we will also be able to advise on whether you should consider a vaginal delivery or an elective caesarean section.
Robotic hysterectomy for uterine fibroids
If future fertility is not a consideration, we can offer a robotic hysterectomy, with or without preservation of the ovaries.
A robot-assisted laparoscopic hysterectomy is similar to a laparoscopic hysterectomy, but using natural wrist movements to control a sophisticated system of robotic surgical tools from outside the body, while viewing the whole operation in 3D via a screen.
If the ovaries are removed, you'll be in menopause following the surgery. If the ovaries were preserved then your menopause will either come naturally or possibly slightly earlier than would have been the case without surgery.
We will ask you to abstain from sex and avoid lifting heavy objects for six weeks after the operation.
Most people report that the operation succeeded in improving or curing their main problem (for example, pain or heavy periods), and have no serious problems or complications afterwards.
What are the potential risks?
We’ll discuss any risks and side effects from fibroid surgery with you in detail. It’s important to remember that no surgery is risk-free and, while the following complications can occur, they are rare:
- Bleeding
- Blood clots in your legs or lungs
- Fluid overload syndrome (when too much fluid is left inside your body after the procedure)
- Infection
- Injury to surrounding nerves, blood vessels, and organs such as your intestines and urinary tract
- Uterine perforation (damage to the uterus wall)
Your safety and wellbeing is our number one priority, and our surgical and anaesthetic team are dedicated to making sure your surgery and subsequent recovery are smooth and complication free.
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