Uterine Fibroids are benign lumps that grow on the uterus. They are non-cancerous .They are usually asymptomatic, but can cause a number of clinical symptoms, such as,

o Abnormal uterine bleeding especially heavy menstrual flow,

o Infertility,

o Recurrent pregnancy loss,

o Cramping lower abdominal pains,

o Pain during sexual intercourse

o An urge to urinate frequently and

o other symptoms caused by compression of the fibroids on adjacent organs.

Diagnosing Uterine Fibroids:

Ultrasound is the most common method, but a diagnostic MRI or hysteroscopy may be necessary if surgery is being considered. A gynaecologist may choose 'watchful waiting' rather than early therapy if the patient's fibroid symptoms are mild or non-existent. However, this may change if a fibroid is found to be the root cause of infertility or repeated miscarriages. When symptoms manifest, therapeutic options for fibroids should be considered. Whether hormone therapy or surgery is the best course of action will largely be determined by how severe the symptoms are and the number and location of the fibroids. Medical treatment is typically the first line of defence for irregular uterine bleeding. When, alternative treatments have failed, surgery may be tried first.

Surgical Choices

Depending on the size, quantity, and position of the fibroids, as well as the existence or absence of associated intra-abdominal issues, a variety of surgical treatments are available, including an abdominal approach (laparoscopy or open procedure), embolization of the feeding blood vessels or hysteroscopic removal of the fibroid. The gynaecologist will advise you and assist you choose the best course of treatment.

In the early 1990s, surgeons began using laparoscopes to do procedures inside the abdomen. Whether a laparoscopic or open incision is made, the operative procedure itself is identical. The incisions made for a laparoscopic procedure are small.
When we talk about minimally invasive surgery, referring to procedures that cause as little trauma to the patient as possible. Instead of the large incisions required for traditional open surgery, minimally invasive treatments only need to make incisions between 5 and 10 millimetres long.
There is less postoperative pain, discomfort and medication use following laparoscopic procedures, and patients recover more quickly.
• the cosmetic outcome is vastly improved
• faster recovery time after hospitalisation
Day-care surgery is an option for most of these treatments.
However, there are a number of cases in which a laparoscopic surgery, once begun, cannot be finished laparoscopically, for a variety of reasons.
 Inflammation that has not subsided inside the abdominal cavity.
 Previous abdominal surgery had left significant adhesions between abdominal tissues.
 Uncertain anatomical details, despite high-quality imaging.
 The anxiety of surgery could result in a miscarriage if the woman is pregnant.
 There is a risk of potentially lethal embolization if air gets into the placental sinusoidal.
 anomalies that have gone undetected in the past.
 Complications during surgery, such as excessive bleeding.
 The need to go from laparoscopy to open surgery is not a problem, but rather evidence that the procedure cannot be performed safely on this patient using laparoscopy and that all safety measures have been taken.
 The end goal is risk-free surgical procedures. There are some patients who are not good candidates
for laparoscopic surgery.
 despite this fact, laparoscopic surgery has a number of benefits over the open technique and at
present is the preferred access for most surgeries.

Female sterilisation procedures often involve the ligation of both uterine tubes. By blocking off the Fallopian tubes, the sperms that enter the female genital tract are unable to reach the eggs released from the ovary. Either a tight ring (band) is used to clamp off the fallopian tubes or, a small section of the tubes is divided and cut away.
Since tubal ligation is potentially irreversible, it should only be considered once a woman has decided that she has finished bearing children and has no plans to have more children or start another family. The procedure can be done in a single day. A patient is often hospitalised in the morning and discharged in the late afternoon. A 5mm incision within the belly button scar and a 7mm incision on one side of the abdomen
are required. Under general anaesthesia, these incisions are used to introduce the laparoscope camera and the band applicator. If the patient wants more children, has a medical condition that necessitates the removal of the uterus or both ovaries, or is unsure about what permanent sterilisation entails, she is not a good candidate for laparoscopic surgery.

The majority of facilities doing the procedure have been reporting excellent results from this technique.
 a one-in-two hundred pregnancy failure rate
 The incidence of tubal (ectopic) pregnancy is one in two hundred pregnancies.
 Tubal recanalization has a success rate of 40-50% (if one changes their mind and wants to conceive in
the future).

Like other laparoscopic operations, tubal sterilisation might have complications.
To name a few:
 Abdominal blood vascular and intestinal injuries.
 Complications from anaesthetic.
 Conversion to laparotomy (open surgery) may be necessary if any of the following hazards materialize during the procedure:
 thermal harm to surrounding structures due to electrocautery.

A myomectomy is surgery to remove growths or myomas from the uterus. The uterus does not get removed out during this operation. When women with uterine fibroids want to get pregnant later or only want to keep their uterus for the psychological benefit of having regular periods, myomectomy is the best way to treat them.

If you have fibroids in your uterus, you might have heavy or painful periods. If a fibroids is big enough, it can put pressure on nearby organs like the ureters and bowels, or it could be the reason you cant bear children. The above symptoms are signs that you should get a procedure called a myomectomy to get free of fibroids.

There are three types of myomectomy: open abdominal myomectomy, laparoscopic myomectomy, and hysteroscopic myomectomy. To get to the uterus during an open abdominal myomectomy, a pretty sizable cut is made in the abdominal wall. This is done less often now and only when laparoscopy is not an option because of a medical or surgical challenge.

Laparoscopic myomectomy is better than open myomectomy because it is less invasive, causes less pain and bleeding, and lowers the risk of infection. Patients also stay in the hospital for less time and heal faster. With a special tool called a Morcellator, even big tumors can be removed laparoscopically as thin strips through openings that are 12 mm wide.

Submucous myomas are the name for fibroids that protrude out into the endometrial canal. The hysteroscopic myomectomy method can get cleared of them without having to open the abdomen or do laparoscopy. As a result, it has the quickest healing time after surgery.

By “hysterectomy” we mean “uterus removal”

Hysterectomy is recommended for women who have tried medical or non-surgical treatments but have not been able to get free of abnormal vaginal bleeding, symptomatic
fibroids, or endometriosis.

Uterine prolapse and cancer of the uterus, ovaries, or cervix are also indications. Total hysterectomy is the medical term for the surgery in which the uterus and cervix are
removed. It is often done along with a bilateral salpingo-oophorectomy, which means that both the fallopian tubes and the ovaries are removed. A radical hysterectomy is when the
uterus, cervix, both fallopian tubes, ovaries, and the connective tissue around them (called parametrium) are removed from a cancer patient.

The open method or the laparoscopic method can be used to do a hysterectomy. Today, the laparoscopic method is usually more appealing, and it is the first choice unless there is a
special reason why it shouldn't be used. Because there is less damage to organs and the cuts in the abdominal skin are very small,
laparoscopy is also known as minimally invasive surgery or key hole surgery.

For a laparoscopic hysterectomy, a camera is put in through a 1 cm hole in the abdominal wall, and other instruments are put in through 0.5 cm cuts. When compared to the open method, the laparoscopic method for hysterectomies has
many benefits. There is a lower chance of infection and pain after surgery, a shorter stay in the hospital, faster recovery, and a faster return to normal activities. The incisions are also
smaller, measuring 5mm to 1cm instead of 10 to 13cm in the open technique.

Along with the usual risks of surgery, laparoscopic surgery comes with the chance of infection, bleeding that needs blood transfusions, and damage to the urinary bladder,
intestines, or ureters. If any of these things happen, the operation could have to be changed to an open one, called laparotomy.

Ovarian cysts are abnormal sacs filled with fluid that can form on the ovaries. Ovarian cysts are common and can happen to people of any age. Normal functional cysts that aren’t dangerous include follicular cysts, which hold eggs, and corpus luteal cysts, which form after the egg is released from the follicular cyst. Lymph node cysts, endometriomas, and teratomas are some other types of cysts that are not harmful.

Cancerous ovarian tumors are in the other group. Often, the ovarian cysts don't cause any symptoms. It could be found by an ultrasound scan or a pelvic check by a doctor. It can sometimes lead to signs like abdominal pressure, bloating, trouble passing stools, having to go to the toilet a lot, and some women may even experience unusual bleeding patterns in their uterus. In most cases, an ultrasound is enough to make the diagnosis, but sometimes an MRI and biochemical markers like CA125 are needed to prove that the tissue is cancerous.

Watchful waiting can be used as a treatment, especially for physiological cysts, to let them go away on their own. Hormonal treatment can sometimes work for cysts that aren’t too big, especially when they are caused by endometriomas. Cysts that are big, don’t go away, or cause severe symptoms need surgery to be treated.

The best way to remove cysts now, when surgery is needed, is through a laparoscope. It only takes one or two days in the hospital. As a result, the patient has less pain after surgery, a lower chance of getting an infection, and can get back to normal activities faster.

Large sized uteruses normally have multiple fibroids or one huge fibroids

Yes, laparoscopic hysterectomy or removal of uterus is possible even if the uterus size is more than 12 to 14 weeks or even if has fibroid more than 6cm.

Currently laparascopic hysterectomy is considered as a safe and efficient method of hysterectomy.

Laparascopic hysterectomy is clearly associated with decreased blood loss, shorter hospital stay, faster return to normal activities and less chance of postoperative wound infection.

In laparascopy the incisions are small few millimeters in size numbering 3 to 4 compared to a 10cm or more incision size in open hysterectomy

Following are concerns if the uterus is big…..

1.How do we remove it through a small incision?

An instrument called morcellator is used which cuts the uterus into strips which are removed through the small incision.

2.Does the complication rate increase?

As with any surgical procedure laparoscopic hysterectomy has incidence of complications ranging 0.1 to 10% such as injury to intestines, bladder, ureter or to blood vessels.By adequate preoperative bowel preparation and right surgical techniques aswell as training, the complication rate can be kept at the minimum even with large sized uterus.

Pain during menstruation is called dysmenorrhea. It’s the most common menstrual disorder.More than 50% of menstruating women experience this.

90% it is physiological and called Primary dysmenorrhea.It is because of increased levels of naturally occurring chemical called prostaglandin in uterus during menstruation.
Secondary dysmenorrhea is caused by pathologies as endometriosis, adenomyosis, fibroids.

Primary dysmennorhea starts on the day of menstruation and usually lasts for a day or two.Secondary dysmennorhea starts even a week prior,through the menstruation and sometimes even beyond.

Treatment of primary is painkillers and hormones.Treatment of secondary is directed towards the cause.

Depressive feelings after undergoing hysterectomy is not uncommon. It is the result of both physical and emotional stress.

Physical stress triggered by the frustration of not being able to do things which normally one does due to the limitation of physical activity by pain and discomfort.

Emotional stress as a result of a feeling of loosing fertility’’an essential part of a woman’s life [hence womanhood]” .

Usually, this low feeling is short lived. Few tips to get over this feeling:

1.  Think of the medical reason why hysterectomy was done.So you get to understand  that the quality of your life increases.
2.  Daily outdoor walks.
3.  Avoid caffeine if your facing sleep deprivation.
4.  Take help with counselor.