Laparoscopic removal of fibroids and its impact on chronic pelvic pain and menstrual abnormalities

Laparoscopic removal of uterine fibroids, also referred to as myomas or leiomyomas, is a widely used, in our days, minimally invasive surgical technique that aims to manage chronic pelvic pain and menstrual abnormalities associated with these benign tumors. This literature review has as its ultimate goal to provide a comprehensive analysis of the impact of laparoscopic myomectomy on these symptoms. Fibroids are benign tumors that arise from smooth muscle cells of the uterus and they are accountable for a wide variety of symptoms, including abnormal uterine bleeding (AUB), pelvic pressure, dysmenorrhea, dyspareunia, and bulk symptoms. Laparoscopic myomectomy offers an alternative to radical surgeries, which is optimal for women who desire to preserve their fertility or simply wish to retain their anatomical integrity by not having their uterus excised. The surgical procedure is performed with the use of specialized equipment. The laparoscopic instruments are inserted through small incisions and the tumors are removed while the uterus is preserved. The laparoscopic operation is associated with several benefits compared to open abdominal procedures, including decreased perioperative blood loss and need for blood transfusion, reduced postoperative pain, shorter hospital stays, a more rapid recovery, and improved cosmetic results. Prominent are also the beneficial outcomes of the operation in alleviating chronic pelvic pain caused by fibroids and in the normalization of the patient’s menstrual patterns, thus achieving enhanced quality of life for patients. Even if post-surgical pelvic pain reduction and bleeding regulation are some of the pros, long-term pain management and relief as well as improvement in menstruation being maintained over time is the ultimate goal. Although the advantages of laparoscopic myomectomy are numerous, careful patient selection and surgeon expertise are essential to achieve ideal outcomes. Factors including the size, number, and location of fibroids, as well as the patient's overall health and fertility aspirations, must be taken into account. The success of the procedure also depends highly on the surgeon's skills and capabilities in identifying and removing fibroids, as well as preserving and restoring the uterus in a safe condition that would not cause complications such as uterine rupture. Recurrence rates of uterine myomas after laparoscopic myomectomies are a greatly debatable subject, with some studies suggesting higher recurrence rates compared to open abdominal myomectomy due to the inability to palpate the uterus during the laparoscopic procedure even if laparoscopy provides a very clear vision. However, an important potential complication of all surgeries, adhesion formation, seems to be lower with the laparoscopic procedure compared to open surgery. Further research is needed to fully discover, understand, and present with certainty the long-term adhesiogenic potential of laparoscopic myomectomy. Compared to hysterectomy, which provides a more radical and long-term resolution of the problem, laparoscopic myomectomy allows for the targeted removal of fibroids and addressing abnormal uterine bleeding while preserving the women’s childbearing potential. In conclusion, laparoscopic myomectomy is a safe, effective, and minimally invasive surgical technique for managing chronic pelvic pain and menstrual abnormalities caused by uterine fibroids and improving the patient’s life quality.