UAE: 1.5 kg tumour removed from woman's womb in rare minimally invasive surgery

A 29-year-old Emirati physiotherapist endured months of compression on the spine, and pressure on the bladder. This condition caused frequent urination and pressure in the rectum that led to constipation and pain, and an enlarged belly.

She tried getting relief through workouts, but her condition worsened. Exercising did not show any positive changes. She had no idea about the cause of the problem.

In what could be one of the rare milestones in the field of minimally invasive surgery across UAE, a single fibroid weighing 1.5 kg was successfully removed through laparoscopic myomectomy from an Emirati patient’s womb at Thumbay University Hospital, Ajman.

Fibroids are ‘muscular tumors that grow in the wall of the uterus (womb)’. Many people with the condition, who are diagnosed with smaller fibroids, don't develop symptoms, but the 29-year-old physiotherapist did. She had been suffering from abdominal swelling, gas, frequent urination, and sharp pain in the abdomen post workouts. She had also lost her appetite for many days.

After seeking medical intervention, she was diagnosed with a large fibroid uterus following an ultrasound. The melon-sized fibroid was so big that it covered up her entire stomach and was reaching above the umbilicus.

The procedure, which may have required the opening of the abdomen with a large slit, was done using laparoscopy, leaving minimal scars and preserving her uterus. Four slits, smaller than a centimetre each, were made to remove the fibroid. “The routine placement of the instruments could not be done because the size posed a huge challenge, and hence modifications to the procedure were done to accommodate the instruments, but it was resected successfully in a surgery that lasted three hours,” said Dr Amal Hassan Abddelaziz, head of obstetrics and gynecology, Thumbay University Hospital Ajman.

Risk associated with uterine fibroids

Dr Abddekaziz said that most doctors had offered to remove the uterus completely, considering the severity of the case. “Using laparoscopy to remove just the fibroid, keeping the uterus intact and without the risk of scar formation, was a challenge,”

Fibroids can cause infertility, pose the risk of losing the uterus completely, in addition to heavy menstrual bleeding, and affect the quality of life of the person. Medicos say that in cases of smaller fibroids, it's fair enough to follow them up if they are not affecting the cavity or not causing heavy bleeding, but for symptomatic larger fibroids, it’s advised to remove them because they may get even larger and will further complicate the surgery in the future.

In the Emirati patient’s case, “It had to be resected through a technique called electric morcellation, in which large fibroids are cut into smaller pieces so that they are easier to remove without causing scars. Simply put, we put in a camera along with a few instruments, and subsequently inject medicines that reduce the blood flow and avoid any risk of haemorrhage,” said the doctor.

The doctor used cutting instruments that reduce the blood flow to dissect, helping the tumour to peel off from the uterus itself. “Once it’s removed, the cavity is closed down to ensure there is no collection of blood. Lastly, medications are applied to prevent scar formation so that it doesn't affect the scar in the future. Prior to the surgery, Magnetic resonance imaging (MRI) and an ultrasound of the abdomen were done to verify the nature, of the position, and rule out any malignancy.” Said Dr Abddelaziz.

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