Dubai: Laparoscopic surgeon Dr Nikita Trehan recently removed a 3.05-kg mass from a patient’s uterus that had reached up to her rib margin. The excised mass turned out to be the largest fibroid removed laparoscopically in the UAE.
The fibroids extracted from the Fujairah-based patient were the equivalent of a 36-week-old baby, the size of a full-term pregnancy, Dr Trehan said of the surgery at International Modern Hospital in Dubai.
Fibroids are tumours that develop in the muscle layer of the uterus and are, in most cases, benign. Though in 99 per cent of the cases, they are non-cancerous, there is a chance of malignancy in less than one per cent of the cases.
Removing large fibroids laparoscopically — without resorting to invasive surgery — has many advantages such as minimal blood loss, minimal pain inflicted on the patient, shorter duration of hospital stay and less adhesions, which is bands of tissue that make organs stick to each other leading to pain and infertility.
Dr Trehan explained that fibroids are caused as a result of hormonal oestrogen stimulation in the smooth muscle cells of the uterus. Fibroids are quite common in 40-70 per cent of women in the reproductive age group, which is from the menarche, or the first menstrual cycle, to the menopause stage. In addition to its occurrence in women in the childbearing group, race plays a role in the incidence of fibroids.
"Fibroids are extremely common in some races than others; for instance, incidences are much higher amongst blacks than in Caucasians,” said Dr Trehan. “Also, incidences are high in the Arab population."
Common symptoms of fibroids are heavy or prolonged menstrual bleeding and passage of clots. However, in some cases, it leads to large swelling or mass in the abdomen area, Dr Trehan said.
"Also, we have had women present with kidney problems as the fibroid can press on the ureters, the tubes that carry urine from the kidney to the bladder, which can lead to the damage of the kidneys due to back pressure," she explained.
An increase in the frequency of urination is also a possible symptom as a result of the pressure a fibroid applies on the urinary bladder. Similarly, constipation rectal pain or dyspareunia (painful intercourse) are also likely to take place due to the internal pressure caused by the fibroid.
Fibroids can lead to infertility if they project into the cavity of the uterus, Dr Trehan said. She added that a Laparoscopic Myomectomy was performed on the patient with the large mass in her uterus as she was a young, unmarried girl.
"She was unmarried and was hence obliviously looking at conserving her uterus for future childbearing and had visited many doctors, all of whom told her that a laparoscopic procedure was impossible [and that] even in the case of an open myomectomy [surgical procedure to remove uterine fibroids] she may have to have her uterus removed," said Dr Trehan.
Despite doctors’ opinions, at International Modern Hospital, the young girl’s uterine arteries were clipped and all fibroids were removed through the laparoscopic procedure, leaving her uterus intact for future childbearing. An additional procedure was performed on the patient called laparoscopic uterine artery ligation (LUAL), which prevents the recurrence of fibroids since they are notorious for recurrence.
"Additional benefits of LUAL are it prevents the recurrence of fibroids in 99 per cent of the cases, very small fibroids shrink on their own after LUAL and future childbearing is not hampered by the clipping," said Trehan.
Though one of the consequences of fibroids is infertility, she clarified that women who have children at an earlier age and breastfeed are protected from fibroids to a large extent. Additionally, a new procedure introduced three to four years ago known as laparoscopy gross wedging of uterus allows women who already have children to keep their uterus.
The procedure involves the removal of the central core of the uterus while keeping the outer shell of the uterus intact and structured together. In most cases when the fibroid is small, the gynaecologist will look at several factors before resorting to the removal of the mass.
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