Removal of Uterine Fibroids - What About the Old Fashioned Technique of Laparotomy?
A laparotomy is an incision in the abdominal wall, either at the bikini line as usually performed for cesarean sections or a midline incision from the belly button down. The utilization and placement of the incision is based on the surgeon's preoperative assessment of the best and safest route for successful completion of the operation.
Traditionally, most fibroid tumors in the uterus are removed through one of these laparotomy incisions.
1 - The ability to fully expose the uterus to maximize removal of fibroids.
2 - The ability for the surgeon to physically appreciate the uterus and feel fibroids that are deep under the surface, removing them as well.
3 - The ability to suture the uterus in multiple layers, creating the strongest closure possible and providing for a stronger uterus later, thus, potentially lowering the chance of the uterus splitting open during a pregnancy.
1 - This approach does involve an abdominal scar which can be several inches or more in length and while these incisions usually heal very well, the scars are sometimes a cosmetic concern.
2 - Usually the laparotomy approach requires at least an overnight stay in the hospital.
3- Pain following a laparotomy is often more significant or requires more medication than the robotic approach.
4 - Some reports have shown greater blood loss with the laparotomy than with the robotic approach, but it is not clear whether these cases are more of an exception or a standard.
5 - The laparotomy approach uses sutures that dissolve rapidly and patients are able to try conceiving as early as 2 months after the procedure, whereas, with the robotic approach, the patient often needs to wait 4 to 6 months for the sutures to dissolve before attempting pregnancy.
The bottom line is that the traditional approach to removing fibroids is tried and true. However, for a woman with very discreet fibroids, that could be approached robotically, a laparotomy may not be necessary as long as the additional delay of pregnancy is acceptable. The laparotomy approach is often superior to the robotic approach in the ability to dig out deeper fibroids which often cannot be visualized with the robot, as well as the fact that it can be accomplished more quickly in the operating room than the robotic surgery.
Newer concerns have also arisen about the potential spread of fibroid tissue around the abdomen because these masses are typically ground up at the time of the robotic surgery. This spread is much less likely with a laparotomy, as the fibroids are removed intact.
It is important for you to talk to your doctor in detail about the pros and cons of each of these surgical options with special consideration for the number and depth of your fibroids and the long-term goals for your planned procedure.