Myomectomy is a surgical operation to remove uterine myomas (myomas) without removing the uterus. Myomas are solid, benign (non-cancerous) masses that grow in the uterus. Uterine myomas can occur at any age, but they often develop during the reproductive period (20-45 years). Uterine myomas (myomas) all differ in shape, location, and size. They can be a single mass or multiple lumps. Uterine myomas are more common in African black women than Caucasian women.

Myomectomy is usually recommended when the patient wants the myomas (myomas) removed but wants to preserve the uterus and fertility. During myomectomy surgery, doctors leave the uterus and reconstruct it by stitching after removing the myomas.

Uterine myomas (myomas) can cause pelvic pain, infertility, pelvic pressure, heavy bleeding episodes, anemia, back pain, incoordination, miscarriage, urinary frequency, or constipation. This procedure is performed under anesthesia in the operating room environment.
Myomectomy can be performed open surgery, laparoscopically or hysteroscopically. All these procedures are performed in the operating room and under anesthesia.

During laparoscopic myomectomy, the abdomen is filled with gas (carbon dioxide) so that surgeons can see the abdominal organs. Then the surgeon inserts a telescopic binocular (a tube with a camera and light) into your abdomen through very small incisions. Then the myomas are removed and removed from the abdomen. After laparoscopic myomectomy, the patient may stay in the hospital for one or two nights. The recovery period after laparoscopic myomectomy can take approximately three weeks.

During hysteroscopic myomectomy, the surgeon removes the myomas through the vagina and there is no need to make an incision in the abdomen. The surgical method chosen (open myomectomy, laparoscopic myomectomy, or hysteroscopic myomectomy) depends on the size and location of the myomas (myomas).

Laparoscopic myomectomy has many benefits over open myomectomy, but suturing the uterus after removing the myomas requires a skilled endoscopic surgeon. Laparoscopic myomectomy is one of the most challenging operations in the gynecological field.

Advantages of laparoscopic myomectomy over open myomectomy;

• Laparoscopic myomectomy causes less blood loss
• Laparoscopic myomectomy has faster recovery and shorter hospital stay
• Less pain after laparoscopic myomectomy compared to open myomectomy
• Although laparoscopic myomectomy is a safe procedure, it is an important operation.

Some of the risks involved in laparoscopic myomectomy;

• Excessive blood loss
• Very rare need for hysterectomy
• When uterine cancer is confused with benign myomas, the possibility of the cancer metastasis is very rare.
• Embolism and/or thrombosis
• Bladder, ureter or bowel injury
• Adverse reactions to the anesthesia procedure
• Abdominal, urinary or wound infection

Laparoscopic myomectomy is a safe procedure when performed by an experienced and skilled surgeon.

Endometriosis is a condition in which tissue normally found inside the uterus develops outside of uterus. While the tissue inside the uterus is called 'endometrium', the condition of this tissue outside the uterus is called 'endometriosis'. Tissues where endometriosis is most common: ovaries, fallopian tubes, intestines and abdominal tissue around the uterus.

The form of endometriosis that localize in the ovary and forms a cyst is called “endometrioma”. It is also known as a "chocolate cyst" because the fluid inside the cyst has the color and texture of chocolate.

Some women with endometriosis have no symptoms, while others may experience severe pain and inability to conceive. There are many treatment options for endometriosis. Endometriosis treatment should be customized according to the patient's characteristics.

Causes

The exact cause of endometriosis is unknown. There are four theories that have been accepted so far. The most common of these is the theory that menstrual blood and some intrauterine tissues along with the blood flow back into the fallopian tubes and intra-abdominal cavity. Thus, the intrauterine tissue poured into the abdomen will grow there. This is called the "retrograde theory of menstruation." Many mutations have been shown to create a genetic predisposition associated with endometriosis. Today, molecular and genetic studies continue intensively.

Symptoms

Some women do not develop any symptoms (complaints). The most common symptom is pain in the pelvis (lower abdomen) (especially with the menstrual period). In some women, painful menstrual cycles may worsen by time.

Pain in women with endometriosis may occur in the following situations:

• Just before or during the menstrual period.
• Between menstrual periods, it is more severe during the menstrual period.
• During and/or after sexual intercourse.
• While urinating or defecating (especially during menstruation).

Of course, pelvic pain can be caused by many other causes as well. During a pelvic exam, we may be able to understand the cause of the pain.

In addition to pain, endometriosis may also cause difficulty to be pergnnat. This may be because endometriosis leads to scar tissue formation that damages the ovaries or fallopian tubes. If you are pregnant, endometriosis will not harm the pregnancy. Pregnancy usually reduces the symptoms of endometriosis.

Diagnosis

Based on your symptoms, your doctor may suspect endometriosis. The only way to definitively diagnose endometriosis in a person is to examine a tissue sample in pathology. This does not always mean that surgery is necessary. Gynecological examination and ultrasound may lead to high suspicion in the diagnosis of endometriosis.

In women who have had surgery, we classify endometriosis as mild, moderate, and severe, based on the findings at surgery. While women with mild preoperative complaints may have severe and widespread endometriosis, the reverse is also possible.

Treatment

There are many treatment options for endometriosis. Common treatment methods include:

• Birth control pills
• Non-steroidal anti-inflammatory drugs
• Other hormone treatments (Progestins, GnRHa)

Surgery (Laparoscopy)

The best treatment option will be recommended according to your age, complaints, examination findings and possible future pregnancy plans. When deciding on surgery or drug therapy, we consider that ovarian reserve may decrease slightly after surgery, endometriosis/ endometrioma is a recurrent disease, and there may be a further decrease if reoperation is required in ovarian reserves.

If we recommend medical treatment (drug therapy), we provide detailed information about the benefits and harms, side effects, how often and for how long to use.

Surgery may be recommended in the following situations:

• Very severe pain, tenderness, especially in a specific region
• No response to drug therapy
• If the patient is unable to be pregnant and the cause is thought to be endometriosis.
• If there is a possibility of malignant tumor in the chocolate cyst

The purpose of the surgery is the removal of endometriosis and scar tissue. Within a few months after surgery, 80-90% of patients will have less pain complaints.

We almost always prefer laparoscopy (keyhole surgery) in endometriosis surgeries.