Myomectomy (my-o-MEK-tuh-me) is a surgical procedure to remove uterine fibroids — also called leiomyomas (lie-o-my-O-muhs). These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years, but they can occur at any age.
The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes your entire uterus, a myomectomy removes only the fibroids and leaves your uterus.
Women who undergo myomectomy report improvement in fibroid symptoms, including decreased heavy menstrual bleeding and pelvic pressure.
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Type of myomectomy surgery
A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, a laparoscopic myomectomy or a hysteroscopic 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.
Blood loss during the surgery may require a blood transfusion. Some women store their blood before the operation in order to receive their own blood rather than blood from the blood bank.
Most women spend two nights in the hospital and four to six weeks recovering at home. After the procedure, you will have a four-inch horizontal scar near your pubic hair or "bikini" line.
After a myomectomy, your doctor may recommend a Caesarean section (C-section) for the delivery of future pregnancies. This is to reduce the chance that your uterus could open apart during labor. The need for C-section will depend on how deeply the fibroids were embedded in the wall of the uterus at the time of surgical removal.
It is also important to note that new fibroids may develop, resulting in recurrent symptoms and additional procedures.
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. The abdominal cavity is then filled with carbon dioxide gas. 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.
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Only women with submucosal fibroids are eligible for a hysteroscopic myomectomy. Fibroids located within the uterine wall cannot be removed with this technique.
This is an outpatient surgical procedure, during which the patient is usually asleep. During the procedure, you will lie on your back with your feet held in gynecology stirrups. A speculum is placed in the vagina. A long, slender "telescope" is placed through the cervix into the uterine cavity. Fluid is introduced into the uterine cavity to lift apart the walls. Instruments passed through the hysteroscope are used to shave off the submucosal fibroids.
After the procedure, you will be able to go home after several hours of observation in the recovery room.
You may experience cramping and light bleeding after the procedure. Typical recovery involves one to four days of resting at home. You will not have any scars on your skin after the procedure.
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Good candidate for Myomectomy
Myomectomy is an option for women with fibroids who wish to get pregnant in the future, or who want to keep their uterus for another reason.
Unlike a hysterectomy, which takes out your entire uterus, myomectomy removes your fibroids but leaves your uterus in place. This allows you to try for children in the future.
The type of myomectomy your doctor recommends depends on the size and location of your fibroids:
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What can one expect from Myomectomy?
Immediate relive from troublesome symptoms of fibroids is anticipated following this surgery. Complete recovery takes place after 2-3 weeks after a laparoscopic Myomectomy, while abdominal / open Myomectomy requires 4-6 weeks for a complete recovery. Heavy and weight bearing activities such as lifting heavy objects, running, climbing stairs, driving and strenuous exercises are asked to be avoided during the recovery phase. Surgeon may also advice to avoid intercourse and using tampon till complete recovery takes place. It is also advisable to wait till three months after surgery before attempting for conception.
You will still have your uterus and all reproductive organs following myomectomy. Once healed, there should be no effects on your sexual activity, and you should still be able to conceive. Depending on the depth of the scar in your uterus, you may require an elective caesarean section at 38 weeks to safely give birth. If you are seeking myomectomy as a remedy to excessive menstrual bleeding, it is important to know that the operation is unsuccessful in around 20 per cent of cases - your heavy menstrual flow may be due to factors other than fibroids. See your doctor for further information and advice.
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Myomectomy surgery risk
Myomectomy has a low complication rate. Still, the procedure poses a unique set of challenges. Risks of myomectomy include:
During myomectomy, surgeons take extra steps to avoid excessive bleeding. These may include blocking flow from the uterine arteries by using tourniquets and clamps and injecting medications around fibroids to cause blood vessels to clamp down. However, most steps don't reduce the risk of needing a transfusion.
In general, studies suggest that there is less blood loss with hysterectomy than myomectomy for similarly sized uteruses.
In 2014, the Food and Drug Administration (FDA) cautioned against using a laparoscopic power morcellator for most women undergoing myomectomy. The American College of Obstetricians and Gynecologists (ACOG) recommends you talk to your surgeon about the risks and benefits of morcellation.
Strategies to prevent possible surgical complications
To minimize risks of myomectomy surgery, your doctor may recommend:
Some research suggests that intermittent GnRH agonist therapy, over time, can shrink fibroids and decrease bleeding enough that surgery isn't needed.
In most women, GnRH agonist therapy causes symptoms of menopause, including hot flashes, night sweats and vaginal dryness. However, these discomforts end after you stop taking the medication. Treatment generally occurs over several months before surgery.
Evidence suggests that not all women should take GnRH agonist therapy before myomectomy. GnRH agonist therapy may soften and shrink fibroids so much that their detection becomes more difficult. The cost of the medication and the risk of side effects must be weighed against the benefits.
Another family of drugs called selective progesterone receptor modulators (SPRMs), such as ulipristal (ella), may also shrink fibroids and reduce bleeding. Outside the United States, ulipristal is approved for three months of therapy before a myomectomy.
Before Myomectomy surgery
Gather information. Before surgery, get all the information you need to feel confident about your decision to have a myomectomy. Ask your doctor and surgeon questions.
Follow instructions about food and medications. You'll need to stop eating or drinking anything in the hours before your surgery, follow your doctor's recommendations on the specific number of hours. If you're on medications, ask your doctor if you should change your usual medication routine in the days before surgery. Tell your doctor about any over-the-counter medications, vitamins or other dietary supplements that you're taking.
Discuss the type of anesthesia and pain medication you may receive. Abdominal, laparoscopic and robotic myomectomies are performed under general anesthesia, which means you're asleep during the surgery. Hysteroscopic myomectomy is performed under general anesthesia or spinal anesthesia, where medication is injected into your spinal canal to numb the nerves in the lower half of your body. Ask about pain medication and how it will likely be given.
Arrange for help. Your facility may require that you have someone accompany you on the day of surgery. Make sure you have someone lined up to help with transportation and to be supportive.
Plan for a hospital stay if necessary. Whether you stay in the hospital for just part of the day or overnight depends on the type of procedure you have. Abdominal (open) myomectomy usually requires a hospital stay of two to three days. In most cases, laparoscopic or robotic myomectomy only requires an overnight stay. Hysteroscopic myomectomy is often done with no overnight hospital stay.
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During Myomectomy Surgery
The procedure will differ depending on what type of myomectomy you’re having.
During this procedure, you’ll be placed under general anesthesia.
Your surgeon will first make an incision through your lower abdomen into your uterus. This can be done in a couple of ways:
Once the incision is made, your surgeon will remove your fibroids from your uterine wall. Then they’ll stitch your uterine muscle layers back together.
Most women who have this procedure spend one to three days in the hospital.
While you’re under general anesthesia, your surgeon will make four small incisions. These will each be about ½-inch long in your lower abdomen. Your belly will be filled with carbon dioxide gas to help the surgeon see inside your abdomen.
The surgeon will then place a laparoscope into one of the incisions. A laparoscope is a thin, lighted tube with a camera on one end. Small instruments will be placed into the other incisions.
If the surgery is being done robotically, your surgeon will control the instruments remotely using a robotic arm.
Your surgeon may cut your fibroids into small pieces to remove them. If they are too large, your surgeon may change to an abdominal myomectomy and make a larger incision in your abdomen.
Afterward, your surgeon will remove the instruments, release the gas, and close your incisions. Most women who have this procedure stay in the hospital for one night.
You will get a local anesthetic or be placed under general anesthesia during this procedure.
The surgeon will insert a thin, lighted scope through your vagina and cervix into your uterus. They’ll place a liquid in your uterus to widen it to allow them to see your fibroids more clearly.
Your surgeon will use a wire loop to shave off pieces of your fibroid. Then, the liquid will wash out the removed pieces of fibroid.
You should be able to go home the same day as your surgery.
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After the operation, you can expect:
Be guided by your doctor, but general suggestions include:
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Results of Myomectomy
Outcomes from myomectomy may include:
Fibroids that your doctor doesn't detect during surgery or fibroids that are not completely removed could eventually grow and cause symptoms. New fibroids, which may or may not require treatment, can also develop. Women who had only one fibroid have a lower risk of developing new fibroids — often termed the recurrence rate — than do women who had multiple fibroids. Women who become pregnant after surgery also have a lower risk of developing new fibroids than women who don't become pregnant.
Women who have new or recurring fibroids may have additional, nonsurgical treatments available to them in the future. These include:
Some women with new or recurring fibroids may choose a hysterectomy if they have completed childbearing.
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