Myomectomy is the removal of fibroids (non-cancerous tumors) from the wall of the uterus. Myomectomy is the preferred treatment for symptomatic fibroids in women who want to keep their uterus.Doctors pursue the following goals through myomectomy or uterine fibro surgery:
- A myomectomy can remove uterine fibroids that are causing such symptoms as abnormal bleeding or pain.
- It is an alternative to surgical removal of the whole uterus ( hysterectomy ).
- The procedure can relieve fibroid-induced menstrual symptoms that have not responded to medication.
- Myomectomy also may be an effective treatment for infertility caused by the presence of fibroids.
Types of myomectomy or uterine fibroid surgery
A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids. Types of metomectomy include:
Abdominal Myomectomy: Also known as an “open” myomectomy, an abdominal myomectomy is a major surgical procedure. It involves making an incision through the skin on the lower abdomen, known as a “bikini cut,” and removing the fibroids from the wall of the uterus. The uterine muscle is then sewn back together using several layers of stitches. You will be asleep during the procedure. Most women spend two nights in the hospital and four to six weeks recovering at home.
Laparoscopic Myomectomy: Only certain fibroids can be removed by a laparoscopic myomectomy. If the fibroids are large, numerous or deeply embedded in the uterus, then an abdominal myomectomy may be necessary. Also, sometimes during the operation it is necessary to switch from a laparoscopic myomectomy to an abdominal myomectomy. You will be asleep during the procedure, which is performed in the operating room. First, four one-centimeter incisions are made in the lower abdomen: one at the navel (belly button), one below the bikini line (near the pubic hair) and one near each hip. A thin, lighted telescope, called a laparoscope, is placed through an incision, allowing doctors to see the ovaries, fallopian tubes and uterus. Long instruments, inserted through the other incisions, are used to remove the fibroids. The uterine muscle is sewn back together. At the end of the procedure, the gas is released and the skin incisions are closed. Most women spend one night in the hospital and two to four weeks recovering at home. After the procedure, you will have small scars on your skin where the incisions were made.
Hysterectomy Myomectomy: This surgery removes your uterus. It may be the best option if your fibroids are large, you have very heavy periods, or if you know you don’t want children in the future. The kind of hysterectomy you get depends on the size of your fibroids. If they’re small, your doctor might be able to do the surgery through your vagina. But if they’re large, she might need to cut open your abdomen.
Preoperative preparation for myomectomy
- Before you have surgery, your doctor may prescribe medication to reduce the size of your fibroids and make them easier to remove. Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are drugs that block production of estrogen and progesterone. They will put you into temporary menopause. Once you stop taking these medications, your menstrual period will return and pregnancy should be possible.
- You might need tests to make sure you’re healthy enough for surgery. Your doctor will decide which tests you need based on your risk factors. These can include: blood tests، electrocardiogram، MRI scan and pelvic ultrasound.
- You may have to stop taking certain medications before your myomectomy.
- If you smoke, stop six to eight weeks before your surgery. Smoking can slow your healing process as well as increase your risk of cardiovascular events during your surgery.
- You will need to stop eating and drinking by midnight the night before your surgery.
Complications and Risks of Myomectomy
The risks of a myomectomy performed by a skilled surgeon are about the same as hysterectomy (one of the most common and safest surgeries). Removing multiple fibroids is more difficult and slightly more risky. Possible complications include:
- blood loss
- weakening of the uterine
- future deliveries need to be performed via cesarean section
- adverse reactions to anesthesia
- internal scarring
- possible infertility
- reappearance of new fibroids