The Two Part Uterine Fibroids Technique

How I found a way to keep my uterus and quickly get back to my daily life

By: Hope Waltman
(Page 2)

Dr. John George, Director of Gynecologic Endoscopy at Washington Hospital Center, describes the Laparoscopic Myomectomy that he performed.

Dr. John George Dr. George said, “I spoke to the patient in question who is recovering nicely. Her surgery was an outpatient laparoscopic myomectomy on Monday, October 27, 2008. She is up and around and happy to be going on short trips to the store. Susan anticipates returning to full activity two weeks after her surgery.

Susan is 37 years of age, African American, single and without children. Her fibroid uterus had grown to the size of a 22-week pregnancy. She could no longer tolerate the large abdominal size, pressure on her bladder and abnormal uterine bleeding. She wanted to preserve her uterus but did not want to be disabled for six weeks from an abdominal myomectomy. She consulted Dr. James Spies, an Interventional Radiologist, but was not a good candidate for Uterine Fibroid Embolization because one of the fibroids was pedunculated. Dr. Spies agreed to do the UFE if I would perform a laparoscopic myomectomy the following week to remove the pedunculated fibroid.

At laparoscopy, I easily removed the pedunculated fibroid. After careful evaluation of the entire uterus I thought that it was feasible to remove all fibroids. I proceeded to remove at least 12 fibroids from all levels of the uterus. The combined weight was 1063 grams, (a normal uterus weighs 80 grams). Blood loss was not excessive. There were no operative or post-operative complications.

I am not aware of similar cases in which all fibroids were removed by laparoscopy after UFE. It is my impression that embolization by decreasing the blood supply to the uterus makes laparoscopic myomectomy more feasible.

While I perform more than 90% of myomectomies as outpatient laparoscopic, the procedure is tedious and requires careful patient selection, precise operative techniques including methods to minimize blood loss, laparoscopic suture reconstruction of the uterus, and a reliable method of removing the fibroids from the abdomen.

I tend to deselect patients with more than ten fibroids or an overall uterine size greater than 20 weeks.”