Myomectomy Surgery: Procedure, Types, Recovery and Fertility
Myomectomy Surgery (my-o-MEK-tuh-me) is a surgical removal of uterine fibroids. It is also called leiomyomas. These are noncancerous and usually occur in the childbearing years but can occur at any age.
Hysterectomy is another procedure to remove fibroids, but the whole uterus is removed. But only the fibroids are removed in myomectomy. The uterus remains intact.
Table of Contents
Why Is It Done?
The doctor recommends a myomectomy surgery if the woman has fibroids in the uterus, causing troublesome symptoms and interfering with everyday activities. Here are the reasons to opt for a myomectomy instead of a hysterectomy.
How Myomectomy Surgery Performed?
The surgeon chooses one type of procedure, usually depending on the location, size, and number of fibroids.
It is suitable for patients having large fibroids present in the uterus. In this surgeon makes a cut in your lower belly to access your uterus and remove fibroids. The surgeon prefers making a low horizontal incision. A vertical incision is needed for larger uteruses.
It is done if the fibroids are fewer in number and smaller in size. Through this process, surgeons remove fibroids through many small incisions. Then insert a narrow tube fitted with a laparoscope camera into your abdomen. This is less invasive, and recovery is fast than abdominal myomectomy.
Hysteroscopic myomectomy is performed when the uterine fibroids are smaller in size. They use a particular scope inserted through the vagina and cervix into the uterus to remove your fibroids.
Risks and Complications
Myomectomy surgery is a safe procedure but might include some risks and complications, such as: –
Excessive Blood Loss
Many women are anaemic or have a low blood count because of heavy menstrual bleeding. So, doctor suggests various ways to build up blood count before the myomectomy surgery. They also take several measures to reduce excessive bleeding and do this by injecting some medicines around the fibroids to cause blood vessels to clamp down.
Complications during Childbirth or Pregnancy
Myomectomy surgical procedures can cause some risk during delivery if the woman is pregnant. Suppose the surgeon had to make a significant deep incision in your uterine wall during the myomectomy surgery.
In that case, the doctor who manages your pregnancy may recommend a C-section delivery to avoid rupture of the uterus wall during labour. This is, though, an infrequent complication of pregnancy.
Removing fibroids incisions into the uterus may result in adhesions, a band of scar tissue that may grow after surgery. There are fewer adhesions in laparoscopic myomectomy than in abdominal myomectomy.
Chance of Hysterectomy
In some rare cases, surgeons remove the uterus if there is excessive bleeding, or any other abnormalities observed during the surgery besides fibroids.
Rare Chance of Spreading a Cancerous Tumour
Sometimes a fibroid can be mistaken for a cancerous tumour. And taking out of a tumour, especially when it is broken into pieces to remove it through a small incision, can spread cancer. The risk of this increases with the women’s age, especially after menopause.
Complications With Myomectomy Surgery
Following are some ways recommended by the doctor to reduce the possible risk associated with myomectomy surgery: –
Iron supplements and Vitamins
Your doctor may recommend iron supplements and vitamins to build up your blood count before surgery if you are anaemic and has encountered heavy blood flow during the menstrual cycle.
Therapy to Shrink Fibroids
The doctor may recommend some therapies like Gn-RH therapy to shrink fibroids and the uterus. These therapies help surgeons to perform minimally invasive surgery by forming a small horizontal incision rather than larger vertical incisions. Doctors can also do a laparoscopic myomectomy instead of an open procedure.
In many patients, the Gn-RH agonist may also lead to the symptoms of menopause which includes night sweats, hot flashes, and vaginal dryness. However, all these symptoms are temporary and will stop when the patient stops taking the medications. This treatment usually happens many months before the surgery.
The studies suggest that the Gn-Rh agonists are unsuitable for all women, and the doctor should make the decision after reviewing the actual problem and condition of the patient. However, the Gn-RH agonist helps to shrink the fibroid by softening it and making the removal process more accessible.
2. Hormonal Treatment
Hormonal treatment before surgery helps to correct anaemia. The doctor may suggest a gonadotropin-releasing hormone (GnRH) agonist, birth control pills, or other hormonal medication decrease excessive blood loss during the menstrual cycle. This allows you to rebuild the blood count or haemoglobin in the patient’s body.
Some of the other risks associated with myomectomy are as follows: –
How to Prepare for Myomectomy Surgery?
Before the surgery procedure
Before the myomectomy surgery, the doctor will do a physical examination and check a complete medical history. You may also be asked about past surgeries, age, and if you are planning for pregnancy, family or personal history of fibroids or uterine problems.
The doctor may also advise you about blood tests, MRIs, pelvic ultrasounds, etc., and details about the medications. Accordingly, the doctor will advise whether to continue or not. It would help to inform the doctor about allergies or other health complications like diabetes.
During the surgery procedure
Depending on the location, number, and size of the uterine fibroid’s surgeon may choose one of three surgical approaches to myomectomy: –
(a) Abdominal myomectomy
This surgeon makes a large abdominal incision to access your uterus and remove fibroids through the abdomen. In this surgeon enters the patient pelvic cavity by making one or two horizontal incisions.
(b) Laparoscopic or Robotic Myomectomy
In laparoscopic or robotic myomectomy, a surgeon removes the fibroids by making several small incisions. But compared to robotic myomectomy, in laparoscopic myomectomy has less blood loss, shorter hospital stays, and lower chances of complications.
In laparoscopic myomectomy surgery, the surgeon makes a small incision near your belly button. And then, insert an instrument with a camera attached called a laparoscope into your abdomen.
In robotic myomectomy, surgeons insert an instrument through a small incision, similar to laparoscopic myomectomy. And then control the movement of the device from a separate console.
(c) Hysteroscopic Myomectomy
In this process, the surgeon inserts a small lighted instrument through the vagina into the uterus. Then a sterile salt solution is inserted into the uterus to expand the uterine cavity. The doctor uses either a wire loop resectoscope to cut tissue using electricity or a hysteroscopic morcellator to manually cut the fibroid with a blade.
And then remove the fibroids pieces from the uterus until obliterated. And sometimes, a second surgery is needed if large fibroids are not removed in the first surgery.
After the Surgery Procedure
After the surgery patient may experience some pain for a few days, but the doctor will provide some painkillers. And will also tell you how to take care of yourself and the diet to be followed. Patients are also advised not to perform any lifting, heavyweight, etc. Depending on your procedure, some patients might observe vaginal spotting for a few days.
Symptoms Because of Fibroids
The doctor recommends myomectomy surgery if you experience the following symptoms: –
Suppose you are suffering from uterine fibroids, causing problems in your everyday activities. Then you can use myomectomy surgery to remove it and get relief. However, the surgery type depends on the fibroids’ size and location. Visit the doctor and get the best treatment depending on your condition.