Myomectomy

A surgical procedure to remove uterine fibroids is called myomectomy. Uterine fibroids are also known as leiomyomas.

These are noncancerous growths that can occur at any age but mostly during childbearing years. To reconstruct the uterus and take out symptom-causing fibroids is the main goal of this procedure.

In this procedure, it will only remove hysterectomy which removes your entire uterus. Improvement in fibroid symptoms such as in fibroid symptoms and heavy menstrual bleeding are the result of myomectomy.

Here are the most common reasons to undergo a myomectomy.

If the fibroids causing symptoms interfere with your normal activities, your doctor may suggest myomectomy.

Some of the reasons for choosing myomectomy include:

• You want to keep your uterus.
• You plan to have children.
• Your doctor suspects uterine fibroids might be interfering with your fertility.

Myomectomy has low risk of complications but just like any other tests it carries risks such as:

• Excessive blood loss - due to heavy menstrual bleeding, some women may have anemia leading to blood loss. Your surgeon will take extra steps to avoid excessive bleeding such as including blocking flow from the uterine arteries and injecting medications around fibroids to cause blood vessels to clamp down during the procedure.
• Scar tissue – the incisions in your uterus will lead to adhesions and this could entangle nearby structures and lead to a blocked fallopian tube or a trapped loop of intestine. Sometimes this may lead to Asherman’s syndrome which means difficulty with fertility.
• Childbirth or pregnancy complications – you may have a cesarean delivery if you will have a deep incision in your uterine wall so you can avoid rupture of the uterus during labor which is a very rare complication of pregnancy.
• Rare chance of spreading cancerous tumor – sometimes cancerous tumors can be mistaken as fibroids. If the tumor is removed through small incisions it can lead to the spread of cancer.
• Rare chance of hysterectomy - uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids, your doctor will remove the uterus.

In order to prepare for the myomectomy, your doctor will ask you to not eat and drink anything hours before the surgery.

If you are taking medications, ask your doctor if he is going to allow you to take them before and after the surgery.

Some of the anesthesias that you may receive include:

• General anesthesia – you are asleep during the whole procedure and this is used for abdominal, laparoscopic, and robotic and some hysteroscopic myomectomies.
• Spinal anesthesia – your spinal canal will be injected by medications to numb the nerves and is used for certain hysteroscopic myomectomies. Hysteroscopic myomectomy is done with no overnight hospital stay. Laparoscopic or robotic myomectomy requires an overnight stay while open or abdominal myomectomy usually requires a hospital stay of two to three days.

Here’s what you can expect before, during, and after your myomectomy procedure.

Your surgeon may choose one of three surgical approaches to myomectomy depending on the size, number, and location of your fibroids. In abdominal myomectomy or laparotomy, he will make an opening in your abdomen to remove the fibroids and access your uterus.

Your surgeon enters the pelvic cavity through one of two incisions:

• Vertical incision – your surgeon will start at the middle of your abdomen and extends from just below your navel to just above your pubic bone, this reduces bleeding but is rarely used.
• Horizontal bikini line incision – your surgeon will make an incision of about 2.5 centimeters above your pelvic bone, this will cause less pain and result in thinner scars. This may be 8 to 10 centimeters or longer.

In robotic or laparoscopic myomectomy your surgeon will remove and fibroids through the small abdominal incision. In robotic he will insert instruments through small incisions and these instruments will be controlled from a separate console.

In laparoscopic myomectomy he will make an incision near your belly button and will then insert a laparoscope which is narrow tube fitted with a camera, then he will perform the surgery with instruments inserted through other small incisions in your abdominal wall.

Sometimes the fibroid is removed through a bigger incision in your abdomen so it can be removed without being cut into pieces or your surgeon will cut the fibroids into pieces and removed through a small incision in the abdominal wall. Colpotomy is when the fibroid is removed through an incision in your vagina.

In hysteroscopic myomectomy, your surgeon will remove the fibroids using instruments inserted through your vagina and cervix into your uterus to treat fibroids that bulge significantly into your uterine cavity or submucosal fibroids.

The process of this procedure includes: your surgeon will insert a resectoscope which is a small lighted instrument through your vagina and cervix and into your uterus. He will then insert a clear liquid, usually a sterile salt solution into your uterus to expand your uterine cavity and allow examination of the uterine walls.

Your surgeon will then shave pieces from the fibroid until it aligns with the surface of your uterine cavity using the resectoscope. The removed fibroid tissue washes out with the clear liquid that's used to expand your uterus during the procedure.

Your doctor will prescribe oral pain medications before leaving the hospital. You may experience spotting or staining for a few days up to six weeks. He will also give you restrictions regarding your food and activities.

The results of myomectomy:

• Fertility improvement – and at the same time pregnancy outcomes, wait at least three months before attempting conception to allow the uterus enough healing time after the procedure.
• Symptom relief - most women experience relief of bothersome signs and symptoms such as pelvic pain and pressure and menstrual bleeding.

Tiny tumors that your doctor doesn't detect during surgery could eventually grow or they may be the development of new fibroids.

Women who had only one fibroid compared to women with multiple fibroids have a lower risk of needing to have treatment for additional fibroids.