Robotic surgery available for fibroid removal

Dec. 28—Although they are benign, uterine fibroids can be bothersome causing abdominal pain, bleeding between periods and other discomfort.

Dr. Sanchita Yadalla, an OB-GYN at Medical Center Hospital ProCare Women's Clinic, is now able to remove the growths using the daVinci robot.

"I recently started learning the robotic surgeries. I have been doing laparoscopic surgeries for some time, so this is one more technique and one more avenue that we have," Yadalla said.

Fibroids develop from the muscle tissue of the uterus. The size, shape and location can vary greatly. The location of the fibroids determines whether they can be removed robotically, Yadalla said.

Laparoscopes can be used to see fibroids on the outside of the uterus.

Laparoscopy is two-dimensional and robotic is three-dimensional, which makes it easier to access the fibroid.

"The robot is for really complex cases," Yadalla said.

Seventy to 80 percent of women develop fibroids and it is common in women in their 30s and 40s.

"However, it's more common in African Americans and Asians. African American women, they tend to get them at a younger age and they tend to grow more rapidly in African American women," Yadalla said.

The American College of Obstetricians and Gynecologists believe they tend to get worse because they don't have as much access to care, she said.

Fibroids come in different sizes from small pea-sized ones to large round ones that may be 5 to 6 inches wide, according to information from Yadalla.

She added that the medical community doesn't know why fibroids occur, but some research suggests they develop from misplaced cells that are in the body before birth. The female hormones estrogen and progesterone appear to be involved in their growth, the information said.

Fibroids can be treated with birth control pills and surgery.

Birth control pills can help control the bleeding.

"But birth control pills have hormones like progesterone and estrogen. Sometimes hormones can make the fibroids grow a little bit ... Now we can also use IUDs. We ... have the different classes of medications called GnRH (Gonadotropin-releasing hormone) agonist, so there are various methods to help the fibroids shrink. Fibroids shrink after menopause ...," because of a decrease in estrogen, Yadalla said.

Pregnancy can cause them to grow because there are so many hormonal surges.

"We remove the fibroids by hysteroscopy, which is going through the vagina, going into the uterus or laparoscopy or robotic hysterectomy. But there are other options — ablation, uterine artery embolization."

"It's not a very common procedure; not very popular. They insert small, tiny particles into the uterine vessel that leads to the uterus. That cuts off the blood supply. That shrinks, but doesn't make the fibroid go away. The newer technique is where you do the laparoscopy, so you're looking into the belly and there's a special probe that comes in. You ... stick the probe while you're checking the ultrasound and laparoscopy right in the center of that fibroid and you burn it slowly so it dissolves completely or shrinks it so symptoms go down quite impressively," Yadalla said.

Myomectomy is removal of fibroids only. Yadalla said sometimes fibroids can block the fallopian tubes preventing pregnancy, but once fibroid removal surgery is performed, they can have children.

They will have to have a Cesarean section, though, she said.

Sometimes myomectomy can also lead to excessive scaring, which can lead to infertility, as well.

A hysterectomy can be done if the fibroids are too large.

"It can fill up a whole belly, or it can be as small as the tiny size of a pea. So depending on the size, sometimes you have to open up the belly ... Sometimes we do laparoscopy ... Or if the fibroid is small and tiny and we can access it through the hysteroscopy that means we can go through the vagina. There is no incision on the belly; just go from below and we just kind of shave it off and done ...," Yadalla said.

"With robotic surgery, we can remove the entire uterus and fibroids with a tiny incision at the belly button, or we can push the entire uterus out of the vagina; almost like delivering a baby," she added.

Robotic surgery allows for faster recovery.

"Having a 3D approach for visualization ... it allows us to do difficult, complex cases and the pain is very minimal ... A lot of the surgeons send the patients home the same day. I just started doing this procedure about four months ago and I have been keeping the patients in the hospital, but they're able to go home the same day," Yadalla said.

New fibroids can form after the surgery, but the patients are able to have children afterward.

Symptoms can include changes in menstruation; longer, more frequent or heavy menstrual periods, sometimes with clots; menstrual pain (cramps); vaginal bleeding between periods; anemia from blood loss; pain in the abdomen or lower back (often dull, heavy and aching, but may be sharp) during sex; pressure, difficulty urinating or frequent urination.

Also, constipation, rectal pain, difficult bowel movements; abdominal cramps; enlarged uterus and abdomen; miscarriages; infertility.

Sometimes fibroids cause no symptoms. They can be found during a routine pelvic exam or tests for other problems.

CAT scans and MRIs also can be used.

Most fibroids don't cause problems, but there can be complications. Fibroids that are attached to the uterus by a stem may twist and cause pain, nausea, or fever. Fibroids that grow rapidly or start breaking down may also cause pain.

Occasionally, a woman will go to the ER for something else like heartburn or nausea and vomiting. They find out through a CAT scan that they have fibroids.

If the fibroids are growing rapidly, she would be concerned.

"Is it the fibroids or something else? Is there a cancer that is going on? Even though we know fibroids are benign tumors ... there could sometimes be a co-existing cancer going on," Yadalla said.

Severe anemia can also affect the heart, so treatment is expedited for those patients.