|What Is A Myomectomy?
A myomectomy is a surgical procedure to remove uterine fibroids. Fibroids are benign (non-cancerous) lumps of tissue that can grow in or on the uterus (womb). The surgeon’s goal with myomectomy is to remove the fibroids and leave the uterus intact. An alternative to hysterectomy (hysterectomy involves removing the uterus) myomectomy is an effective way to alleviate some the symptoms of fibroids, such as heavy periods and pelvic pain, if drug therapy is unsuccessful. It is particularly appealing to women who want to retain their fertility. Traditionally hysterectomy was a preferred procedure, the rationale being that because fibroids can grow back, removing the womb would offer a permanent cure. Today, myomectomy is considered a more conservative (and appropriate) approach.
How Is It Performed?
Myomectomy surgery takes 1 to 5 hours to perform and requires general or local anesthesia. There are several types of surgical methods. Which method chosen depends on the size and type of fibroids you have. The 3 approaches are:
Abdominal myomectomy laparotomy: An incision is made across the tummy to access the womb and remove the fibroid(s). It is the preferred option for fibroids that are difficult to remove through the vagina.
Laparoscopic or robotic myomectomy: The surgeon removes fibroid(s) through small tummy incisions made using specialized tools. In some cases a robotic tool is used to perform surgery.
Hysteroscopic myomectomy: Fibroid(s) are removed through the vagina. This procedure is less invasive and is suitable for smaller fibroids.
Abdominal Myomectomy Laparotomy
Hospital stay: 2 to 3 days.
Recovery time: 4 to 6 weeks.
Laparotomy is an open surgical procedure performed under general anesthesia. It involves making an incision in the abdominal wall. With a myomectomy laparotomy, the surgeon makes one of two incisions:
Types of abdominal laparotomy incisions
Vertical: Extends from just below your belly button to the top of your pubic bone. This gives the surgeon good access to the uterus and helps minimize bleeding. Some surgeons recommend this approach if the uterus is swollen to the size it would be were the woman 16 weeks pregnant or more.
Horizontal: Bikini line incision runs about 2.5cm above your pubic bone. It leaves a thinner scar and is less painful post-operative than a vertical incision. However, if you have lots of, or large fibroids it may not be suitable as it limits the surgeon’s access to the womb.
During the procedure the surgeon visually inspects the uterus for fibroids - as well as early 'seed' tumors, thereby reducing the risk of a recurrence. When a fibroid is located it is grasped with a surgical tool and peeled away from the uterus tissue. Any damage to the uterus is then repaired. After surgery you will be monitored in the recovery room. When your anesthesia fades you will be bought to your hospital room. You will be given pain relief medications and encouraged to walk around to reduce the risk of complications. Recovery takes up to 6 weeks, during which time you will need to avoid strenuous physical activity, sexual intercourse, douching and using tampons.
Laparoscopic (keyhole surgery) or robotic myomectomy
Hospital stay: Outpatient (no overnight stay usually required).
Recovery time: 5 days to 2 weeks.
This procedure is less invasive and may be performed under general or local anesthetic. A tiny incision is made in or near the bellybutton and the surgeon inflates the abdomen with carbon dioxide gas to improve his visibility. He inserts a laparoscope through the hole which has a video camera attached. He then inserts small cutting tools through another incision. The fibroid is cut and removed through the incision or through an incision in the vagina (colpotomy). There are no set guidelines as to when laparoscopic surgery is preferable to laparotomy - although some surgeons have self-imposed guidelines which depend on the number of fibroids present. This surgery is easier to perform if the fibroids are located on the outside of the uterus (subserosal fibroids). On the downside it is difficult for the surgeon to repair any damage to the uterus as vision is restricted.
Robotic myomectomy (such as da Vinci surgery, above, the doctor controls robotic cutting tools from a monitor nearby) allows the surgeon to perform more precise laparoscopic surgery than is possible with the human hand, regardless of the size or location of the fibroid. This procedure allows many women, who were once only candidates for laparotomy, to be treated by minimally invasive surgery.
Hospital stay: Outpatient (sometimes 1 night stay).
Recovery time: Less than a week.
Smaller fibroids and those that bulge into the uterine cavity (submucosal fibroids) may be removed through hysteroscopic myomectomy. This procedure is performed under general or spine anesthesia. The surgeon inserts a small lighted tool (resectoscope) through the vagina, up into the cervix and uterus. A clear liquid is squirted into the cavity to improve visibility. The fibroid is shaved until it is even with uterus tissue. The removed tissue washes out with the clear liquid.
What Are The Risks And Complications?
The risk at the hands of a skilled surgeon are minimal, and are similar to those of a hysterectomy (see hysterectomy complications). The risks are:
1. Small risk of excessive bleeding.
2. Scar tissue formation. Adhesions may block implantation of fertilized eggs, but this is rare.
3. New fibroids. Although removed fibroids do not grow back, new ones may form. You surgeon may miss 'seedlings' (new tumors forming). A hysterectomy may ultimately be the only final cure. See, do fibroids grow back? for more information.
4. Childbirth problems. If you had a deep incision in the wall of your uterus, and you become pregnant after, a c-section delivery may be necessary to avoid rupturing the uterus during labor.
How Surgeons Reduce The Risks
You may be given hormone therapy medications (Gn-RH agonist therapy) to reduce the size of your fibroid(s) before surgery. This will hopefully reduce the size enough to provide the option of minimally invasive procedures. In most women therapy produces menopause symptoms like hot flashes and vaginal dryness, but these problems end when you stop therapy. Generally treatment is started a few months before surgery.
After myomectomy, about 80 percent of women report improved pain relief and reduced menstrual bleeding. However, the surgery is not a permanent fix for fibroids. New fibroids usually grow in 25 percent of cases. The younger the woman is and the more fibroids she has before a myomectomy, the more chance she has of fibroids returning. Women nearing menopause are the least likely category to have a recurrence. As such, it is still a valuable alternative to hysterectomy.
What are uterine fibroids?: Quick definition and explanation.
Can fibroids cause weight gain?: Bloated tummy?
Do fibroids cause pain?: If so, what sort of pain?
Can fibroids cause heavy menstrual bleeding?: Painful or heavy menstrual periods.