Лучшие больницы для «Myomectomy (Fibroid Removal Surgery)» в Бангалор, Индия

Uterine fibroids (leiomyomas) are benign smooth-muscle tumors of the myometrium affecting an estimated 70–80% of women by age 50, though only 25–50% become symptomatic. Clinically significant fibroids cause heavy menstrual bleeding (menorrhagia), pelvic pressure, dysmenorrhea, urinary frequency, and, critically for international patients of reproductive age, implantation failure or recurrent pregnancy loss. Fibroid classification by the FIGO (International Federation of Gynecology and Obstetrics) PALM-COEIN system and the FIGO leiomyoma subclassification (Types 0–8) guides both the surgical approach and the expected degree of difficulty: submucosal fibroids (Types 0–2) are best approached hysteroscopically, while intramural (Types 3–5) and subserosal (Types 5–7) lesions require laparoscopic, robotic, or open access.

• Women with symptomatic uterine fibroids causing heavy menstrual bleeding (defined as >80 mL/cycle or PBAC score >100), pelvic pain, bulk symptoms, or urinary/bowel dysfunction
• Patients with submucosal fibroids (FIGO Types 0–2) distorting the uterine cavity who have experienced implantation failure, recurrent miscarriage, or are planning IVF/ICSI
• Women who desire uterine preservation (ruling out hysterectomy) and are not yet in menopause
• Patients with incidentally found fibroids growing rapidly (>1 cm/year on serial ultrasound), particularly to exclude rare uterine sarcoma
• Intramural or subserosal fibroids ≥3 cm causing documented symptoms, or ≥5 cm even with mild symptoms if fertility is desired

Required Pre-Operative Diagnostics:

• Transvaginal and transabdominal pelvic ultrasound (TVS/TAS): fibroid mapping — number, size, FIGO type, relationship to endometrial cavity and serosa
• MRI pelvis with contrast (gadolinium): mandatory for fibroids >6 cm, suspected adenomyosis, pre-operative robotic/laparoscopic planning, and to exclude degenerated or atypical fibroids suggestive of sarcoma
• Saline infusion sonohysterography (SIS) or diagnostic hysteroscopy: to evaluate cavity distortion in submucosal fibroids
• Complete blood count (CBC), serum ferritin, iron studies: quantify anemia burden
• Coagulation profile (PT, aPTT, platelet count): bleeding risk assessment
• +4 more

1. HYSTEROSCOPIC MYOMECTOMY (FIGO Types 0, 1, and selected Type 2 submucosal fibroids)

Performed under general or regional anesthesia as a day-case or overnight procedure. A resectoscope (26–28 Fr) with a monopolar or bipolar electrosurgical loop is introduced transcervically; no abdominal incisions are made. The STEP-W (Submucosal Myoma ESGE Classification) score guides feasibility: scores 0–4 are favorable for complete single-session resection. Advanced platforms include the Truclear Elite and MyoSure REACH tissue-removal systems, which use reciprocating mechanical blades to resect and extract fibroid tissue simultaneously, reducing fluid absorption risk compared to traditional loop resection. For larger Type 1–2 fibroids (>3 cm), a two-stage procedure may be planned 2–3 months apart, with intervening GnRH agonist therapy.

2. LAPAROSCOPIC MYOMECTOMY (FIGO Types 3–7; fibroids ≤10–12 cm; ≤4–5 in number)

Performed under general anesthesia through 3–4 port sites (5–12 mm). A vasopressin solution (0.2–0.4 units/mL, maximum 30 units total) is injected into the myometrium at the pseudocapsule plane to minimize blood loss. Fibroids are enucleated along the pseudocapsule — a fibronectin-rich plane — and the myometrial defect is repaired with multilayer barbed suture (e.g., V-Loc 180 or STRATAFIX) to ensure uterine wall integrity for future pregnancy. Specimen extraction is performed via a mini-laparotomy (2–3 cm) using a contained manual morcellation bag system (e.g., PneumoLiner, Espiner) — this approach complies with FDA and MHRA guidance against open power morcellation due to the theoretical risk of disseminating occult leiomyosarcoma. Blood loss is further minimized with intraoperative tranexamic acid 1 g IV and cell-salvage autotransfusion when estimated blood loss is anticipated to exceed 500 mL.

PHASE 1 — PRE-TRAVEL & WORKUP (Weeks 1–4 before arrival)

• Submit medical records, prior imaging, and pathology reports to GAF Healthcare for specialist review and surgical planning.
• Remote video consultation with the assigned gynecologic surgeon to discuss fibroid map, surgical approach, fertility goals, and consent.
• Complete preliminary blood work and imaging at home if advised; share digital DICOM files of pelvic MRI/ultrasound.
• Begin GnRH agonist/antagonist therapy or IV iron supplementation if prescribed by the receiving team (coordinated with your local physician).
• Obtain e-Medical Visa for India (typically processed in 1–5 business days) or arrange UAE entry visa through GAF Healthcare.

PHASE 2 — ARRIVAL & PRE-OPERATIVE ASSESSMENT (Days 1–2 in country)