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UCLA Fibroid Treatment Program

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Surgical Therapy

Surgery is never a simple decision. We aim to provide our patients with the resources to make well informed choices for treatment. We are equipped with the latest advancements to provide an array of surgical options. Treatment options include surgical, hysteroscopic, laparoscopic, and robotic assisted myomectomy or hysterectomy procedures by board certified physicians of the American Board of Obstetrics and Gynecology.

UCLA is one of only a few centers in Southern California with the technology and surgical expertise to offer Robotic Laparoscopic Myomectomy and Hysterectomy as an alternative.

Myomectomy

Myomectomy removes fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who simply wish to maintain their uterus. This procedure is considered standard of care for removing fibroids and preserving the uterus. Myomectomy has traditionally been performed through a large abdominal incision, however advances in technology have provided less invasive alternatives such as Hysteroscopic and Larparoscopic Myomectomy. While this procedure is more time consuming for the surgeon, it affords patients the opportunity to remain fertile.

Types of Myomectomy

Hysteroscopic Myomectomy

A Hysteroscopic myomectomy removes fibroids through the vagina. In this procedure a long, thin scope with a camera and light is passed through the vagina and cervix into the uterus. No incision is needed. The physician can look inside the uterus for fibroids and other problems, such as polyps. Submucous or intracavitary myomas are easily visualized and can be resected or removed using a wire loop or similar device. While certain fibroids can cause bleeding and anemia, their management is straightforward with hysteroscopic myomectomy. Patients are usually sent home after the procedure and have minimal need for recovery. The hospital stay can last from 30 minutes to 2 hours and recovery time is generally 1-2 days. Generally only fibroids that are small and accessible through the vagina can be treated this way.

Laparoscopic Myomectomy

In Laparoscopic myomectomy, surgeons can view and access the abdomen through a few, small incisions and subsequently remove each Fibroid through the vagina. The Laparoscope is a thin, well light, telescope-like instrument. The Larparoscope removes fibroids through a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. The hospital stay can last from 1-3 days and recovery time is generally 1-2 and less weeks.

NEW Laparoscopic Robotic Myomectomy

Robotic assisted myomectomy is an expansion of laparoscopic myomectomy, with the exception that the specialized laparoscopic instruments are connected to robotic arms which are guided by the surgeon. This allows the surgeon to have enhanced dexterity, precision, and visualization.

Abdominal Myomectomy

An abdominal myomectomy removes fibroids through an incision in the abdomen, ideally a bikini line incision. Abdominal myomectomy allows the surgeon to easily see pelvic organs which can be difficult to visualize for other treatment options when a patient has very large fibroids or multiple fibroids. The hospital stay can last from 1-3 days and recovery time is generally 2-6 weeks. The abdominal myomectomy is a procedure with great success however, due to the invasiveness of the procedure the surgery may entail some additional risk factors which, you can discuss with your team.


Hysterectomy

A hysterectomy is the surgical removal of all or part of the uterus (womb). The doctor may also remove the fallopian tubes, ovaries and, the cervix during the same surgery. Yet, it is important to know that most women undergoing hysterectomy DO NOT need to have their ovaries removed and will therefore not experience menopausal symptoms after surgery.

Hysterectomies are commonly performed as final treatment option for chronic issues such as: Uterine fibroids, Endometriosis, pelvic support problems (i.e uterine prolapse), abnormal uterine bleeding, cancer, and chronic pelvic pain. There are two types of hysterectomy procedures. Depending upon the specific condition, surgeon, and patients medical history a hysterectomy can be performed in one of three ways; laparoscopic, vaginal, and abdominal.

Types of Hysterectomy

  • subtotal or supracervical hysterectomy- removes the uterus but leaves the cervix in place. Research suggests this may reduce the risk of pelvic organ prolapse and preserve sexual function.
  • total or traditional hysterectomy- removes the uterus and cervix completely.
Laparoscopic Hysterectomy

In laparoscopic hysterectomy, surgeons can view and access the abdomen through a few, small (1 to 2-centimeter) incisions, and subsequently remove the uterus through the vagina. A Laparoscope (a thin, well light, telescope-like instrument) is the medical tool used. In cases in which the uterus is large or in partial hysterectomies, the surgeon can use an endoscopic morcellator to cut the uterus into small pieces and then remove it and other tissues through the small incisions in the abdomen. The procedure is associated with faster recovery and fewer complications compared to abdominal hysterectomy. Patients with extensive inflammation, infection or abdominal scarring from previous surgeries may not be appropriate candidates for laparoscopic hysterectomy. Laparoscopic hysterectomy usually requires only 1 day or less in the hospital and less than 2 week of recovery time.



NEW Robotic assisted Hysterectomy (see video)

While still done through the laparoscope, robotic assisted hysterectomy has the added benefit of allowing more complex surgery to be performed avoiding the need for a large incision. This enhancement has been shown to reduce recovery time and pain when compared to traditional abdominal hysterectomy. Robotic assisted Hysterectomy usually requires only 1 day or less in the hospital and less than 2-4 week of recovery time.

Vaginal Hysterectomy

Vaginal hysterectomy is surgical removal of the uterus through an incision inside the vagina. The ovaries and other organs may also be removed based upon the patients needs and condition. This hysterectomy method uses a smaller incision inside the vagina. The advantages of vaginal hysterectomy include shorter hospital stay and recovery time, less pain, lower cost, and no external abdomen scars. Vaginal hysterectomies usually require a 1 day hospital stay and up to 4 weeks' recovery time.

Abdominal Hysterectomy

An abdominal hysterectomy removes fibroids by extracting the uterus through an incision in the abdomen. Abdominal hysterectomy allows the surgeon to easily see pelvic organs so it is especially useful for extremely large fibroids or when additional complications exist. The hospital stay can last from 1-3 days and recovery time is generally 4-8 weeks. The abdominal hysterectomy is a procedure with great success however; due to the invasiveness of the procedure the surgery may entail some additional risk factors.

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