Myomectomy (myoma = fibroids, ectomy = removal) is a surgical procedure that removes fibroids. For women with symptomatic fibroids who do not want a hysterectomy, this is the surgery of choice. A keyhole-shaped technique (laparoscopically) or an open abdominal approach are also options for myomectomy (making a larger surgical incision in the abdomen). Laparoscopic myomectomy offers many advantages over open abdominal surgery, such as:
- Enhanced recovery
- Short hospital stay
- Cosmetically improved scar
- Reduced adhesions (scarring) from the procedure
- Comparable pregnancy rates
What is Laparoscopic Myomectomy?
Laparoscopic myomectomy is an advanced laparoscopic treatment also called robotic myomectomy, it is a surgical procedure to remove fibroids through small abdominal incisions. Laparoscopic myomectomy is suggested and advised for those experiencing problems due to fibroids. This procedure is recommended when the woman wants the fibroids removed but wants to preserve the uterus. Fibroids can cause difficulties such as pelvic discomfort or pressure, excessive menstrual flow, urine frequency, or incontinence, which can disrupt daily life.
Who is a Good Candidate?
A myomectomy is an option for women with fibroids who wish to become pregnant in the future or who wish to preserve the uterus for another reason. Unlike a hysterectomy, which removes the entire uterus, a myomectomy removes the fibroids but leaves the uterus in place. This allows you to try it with children in the future. Depending on the size and location of your fibroids, your doctor may prescribe one of the following types of myomectomy:
- Abdominal myomectomy may be better for you if you have many or very large fibroids growing on the uterine wall.
- Laparoscopic myomectomy may be better if you have smaller and fewer fibroids.
- Hysteroscopic myomectomy may be better if you have smaller fibroids inside the uterus.
Compared to other treatments, laparoscopic myomectomy is considered an effective, appropriate, and safe procedure to remove fibroids from the uterus. Some of the benefits are as follows:
- It causes less blood loss during the operation process.
- Treatment does not take long when the patient is discharged in one day.
- He has a quick postoperative recovery.
Types of Myomectomy
Various techniques are used to remove the fibroid inside the uterus. The choice of technique can depend on several factors, such as the location and size of the fibroids, as well as the characteristics of the woman. Various types of myomectomy include:
It is done to remove fibroids in the uterus. This technique is done using a narrow telescope-like instrument to view the inside of the abdomen. The procedure involves 4 to 5 incisions in the belly button and lower abdomen. Fibroids are shells outside the uterus that repair the incision of the uterus. Recovery time is around 2 to 3 weeks and requires an overnight stay. Complications such as bleeding, injury to internal organs, or minimal infection can occur during this procedure. Robot-assisted laparoscopy is also performed for the removal of fibroids, where the robotic system translates the movement of the surgeon's hand outside the patient's body and the precise surgical movement within the abdomen.
The Vertical or Horizontal Incision
The vertical or horizontal incision in the abdominal wall is used to execute an abdominal myomectomy, commonly known as a laparotomy. It allows the surgeon to have direct access to the uterus of the patient and is performed using traditional surgical techniques and instruments. The patient is given anesthesia and a full recovery is expected in 4 to 6 weeks.
Submucosal fibroma from the inner wall of the uterus is removed during a hysteroscopic myomectomy. A narrow telescope-like instrument is passed through the cervix to visualize the activity of the uterus to allow for surgery inside the uterus. This procedure is only done for smaller fibroids. In an operating room, this technique is performed under anesthesia. Some complications faced during this procedure include fluid overload, bleeding, scar formation within the uterus, and uterine perforation.
Preparing To The Surgery
Before surgery, your doctor may prescribe medicine to shrink your fibroids and make them easier to remove. Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are drugs that block the production of estrogen and progesterone. They will put you in temporary menopause. Your menstrual cycle will return once you stop using these drugs, and pregnancy should be feasible.
When you meet with your doctor to go over the procedure, be sure to ask any questions you have about the preparation and what to expect during the surgery. You may need tests to make sure you are healthy enough for surgery. Based on your risk factors, your doctor will choose which tests you require. These may include:
- Blood test
- Magnetic resonance
- Pelvic ultrasound
You may need to stop taking certain medications before your myomectomy. Tell your doctor about each medicine you take, including vitamins, supplements, and over-the-counter medicines. Ask your doctor which medications you will need to stop taking before surgery and how long you will need to stop taking them. Smoking can slow down the healing process and increase the risk of cardiovascular events during surgery. Ask your doctor for advice on how to quit smoking.
What Happens During The Procedure?
While you are under general anesthesia, your surgeon will make four small incisions. Each will be about ½ inch long in the lower abdomen. Your abdomen will be filled with carbon dioxide gas to help the surgeon see inside your abdomen. The surgeon will then place a laparoscope in one of the incisions. A laparoscope is a thin, lighted tube with a camera attached to one end. Small instruments will be placed in the other incisions. If the surgery is performed 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 switch to an abdominal myomectomy and make a larger incision in your abdomen. Then your surgeon will remove the instruments, release the gas, and close the incisions. Most women who have this procedure stay in the hospital overnight.
You will stay in the hospital for 24 to 48 hours, depending on how well you recover. You may feel some discomfort, especially when moving, but this will be well controlled with pain relief. You may have light vaginal bleeding and some pain in your shoulder. You will feel tired, but you will eat and drink normally, walk, and use the bathroom. You will be discharged from the hospital after 24 to 48 hours.
For the first three days after discharge, we recommend taking pain relievers regularly. You also need to get enough rest (8 hours at night, two hours during the day). You will be seen at the end of the first week for a postoperative review and suture removal. You should gradually increase your activity levels and you should be able to return to work in four weeks.
What Are The Risks Involved in Laparoscopic Myomectomy?
Although laparoscopic myomectomy has few complications and risks involved, unique challenges maybe sometimes faced in some cases. Some of the risks involved in the procedure include:
- Excessive blood loss is greater with a larger uterus. Due to heavy menstrual bleeding, women already suffer from low blood counts (anemia). This creates an increased risk due to blood loss and doctors always suggest ways to increase the blood count before undergoing surgery. To avoid severe bleeding, doctors inject drugs around the fibroids to clamp down on the blood vessels and stop the flow of the arteries to the uterus.
- There may be some risk during pregnancy. Doctors may recommend a cesarean section (cesarean section) if there has been a deep incision in the uterine wall. This is done to prevent the uterus from rupturing during labor, which is a very rare complication during pregnancy. Fibroids are associated with complications during pregnancy.
- There may be a rare possibility of a hysterectomy in which the surgeon removes the uterus if bleeding is uncontrollable and abnormalities other than fibroids are also found.
- There may be little chance that the cancerous tumor will spread, which can be mistaken for fibroids. In case the tumor is removed through a small incision, it can break the tumor into small pieces and spread it. As women age and after menopause, the chances and risk of these cases may increase.
- After surgery, there may be adhesions - bands of scars due to an incision in the uterus to remove the fibroids. Due to the adhesion formed within the uterus, there may be chances of light menstrual periods and difficulty with fertility. The chances of adhesion are greater in laparoscopic myomectomy.