Myomectomy (the removal of fibroid s) is usually carried out as an open operation. Laparascopic (keyhole) surgery for fibroid s is technically more difficult but has the major advantage of a much shorter recovery time following surgery. Large abdominal incisions may also cause adhesion which may have a negative effect on future fertility.
One of the main difficulties in laparoscopic surgery is in repairing the womb once the fibroid has been removed. A proper repair is essential to minimize bleeding at the time of surgery and to strengthen the womb for a future pregnancy. Up until now it has been necessary to close the womb with interrupted stitches, each one individually tied, to obtain a proper closure.
A recent, dramatic advance is the development of the Quill knotless closure system. This is an absorbable suture which has barbs placed along its length which only allow the stitch to be pulled through the tissue in one direction. This enables wound closure with a single continuous suture without knots!
At the Portland hospital a 35 year old woman complaining of heavy bleeding was found to be anaemic and to have a 9cms fibroid deeply embedded in the muscle of her womb. A decision was made to perform a laparoscopic myomectomy.
At the time of her surgery the fibroid was found to extend throughout the whole muscle thickness of the womb. The fibroid was shelled out, the lining of the womb was left intact, but a large cavity was left with a full thickness defect through the muscle of the womb.
This was closed with two continuous Quill sutures. No knots were tied and an excellent result was achieved. The fibroid cavity was completely obliterated, there was minimal bleeding throughout the procedure and the operating time was approximately 45minutes less than anticipated.
This revolutionary new suture system makes it possible to rapidly and effectively close the uterus at the time of myomectomy. This should make the laparoscopic approach to this operation more widely available as more gynaecological surgeons become confident with this technique.
Dr. Christian Barnick
Chris now practices privately at the Portland hospital with OBGYN Matters and still works part-time in the NHS at the Homerton University Hospital
