A myomectomy (myoma = fibroids, ectomy = removal) is a surgical procedure that removes uterine fibroids in women. This is the surgery of choice for women with symptomatic fibroids who do not want a hysterectomy. A keyhole-shaped technique (laparoscopically) or an open abdominal approach are also options for myomectomy (making a larger surgical incision in the abdomen).
Various myomectomy techniques are used to remove the fibroids from inside the uterus. The choice of method can depend on several factors, such as the location and size of the fibroids and the woman's general health. Various types of myomectomy include:
- Laparoscopic myomectomy - For smaller and fewer fibroids.
- Abdominal myomectomy - For many huge fibroids growing on the uterine wall.
- Hysteroscopic myomectomy - For submuscosal fibroids inside the uterus.
Book an appointment with a gynaecologist for a myomectomy surgery.
Laparoscopic myomectomy -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 surgeon performs the surgery by making 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 to remove fibroids, where the robotic system translates the movement of the surgeon's hand outside the patient's body and the precise surgical movements within the abdomen.
An abdominal myomectomy -Also, commonly known as a laparotomy, it is carried out through a vertical or horizontal incision in the abdominal wall. It allows the surgeon to access the patient's uterus directly and is performed using traditional surgical techniques and instruments. The patient is given general anaesthesia, and a full recovery is expected in 4 to 6 weeks.
Hysteroscopic myomectomy -This procedure removes the submucosal fibroma from the inner wall of the uterus. It is only done to remove smaller fibroids without any abdominal incision. A narrow telescope-like instrument is passed through the cervix to examine the uterus activity to begin the surgical procedure. In an operating room, it is performed under general anaesthesia. Some complications faced during this procedure include fluid overload, bleeding, scar formation within the uterus, and uterine perforation.
What is laparoscopic myomectomy?
Laparoscopic myomectomy is an advanced laparoscopic treatment also called a robotic myomectomy. It is a surgical procedure to remove fibroids through small key hole incisions. This procedure is recommended when the woman wants the fibroids removed but wants to preserve the uterus. Uterine fibroids can cause difficulties such as pelvic discomfort or pressure, excessive menstrual flow, urine frequency, or incontinence, and fertility which can disrupt daily life.
Benefits of Laparascopic myomectomy
Laparoscopic myomectomy offers many advantages over open abdominal surgery, such as:
- Enhanced recovery
- A short hospital stay
- Less pain
- Less blood loss
- Cosmetically, improved scar
- Reduced adhesions (scarring) from the procedure
Precautions for myomectomy procedure
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 drugs. 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 problems during surgery. Ask your doctor for advice on how to quit smoking.
How do you prepare for 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, and your menstrual cycle will return once you stop using these drugs, and pregnancy should be feasible.
When you meet with your doctor for the procedure, be sure to ask any questions about the preparation and what to expect during the surgery.
You may need surgical tests to make sure you are healthy enough for surgery. Your doctor will choose which tests you require based on your risk factors. These may include:
- Blood test
- Pelvic ultrasound
- MRI Scan (it rules out whether a fibroid is benign or malignant)
What happens during the procedure?
- While under general anaesthesia, your surgeon will make four small incisions. Each will be about ½ inch long in the lower abdomen. The abdomen will be filled with carbon dioxide gas to help the surgeon see inside the stomach.
- 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. Tiny 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.
- The surgeon may cut your fibroids into small pieces to remove them through urinary system. If they are too large, the doctor may switch to an abdominal myomectomy and make a larger incision in the abdomen.
- When the surgery is over, the instruments are removed, gas released, and incisions closed. Most women who have this procedure stay in the hospital overnight.
Recovery from myomectomy
You will stay in the hospital for 24 to 48 hours, depending on how well you recover. There will be some discomfort, especially when moving, but it will go away with pain-killer drugs. Light vaginal bleeding and shoulder pain may be present. You will be discharged from the hospital after 24 to 48 hours.
As per your doctor's advice, take pain relievers regularly for the first three days after discharge. Also get enough rest (8 hours at night, two hours during the day). You will be called at the end of the first week for a postoperative review and suture removal.
Gradually increase physical activities, and you should be able to return to work in four weeks.
What are the risks related to laparoscopic myomechtomy?
Although laparoscopic myomectomy has few complications and risks involved, unique challenges maybe present in some cases. Some of the risks involved in the procedure include:
- Excessive blood loss is more significant with a larger uterus. Due to heavy menstrual bleeding, women suffer from low blood counts (anaemia). This creates an increased risk due to blood loss, and doctors always suggest ways to improve 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 risks 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 labour, an infrequent 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. If it is removed through a small incision, it can break the tumour 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 a chance of light menstrual periods and difficulty with fertility.
Myomectomy Care at Medicover Hospital
Medicover hospital has some of the top gynecologists, laparoscopic surgeons, and obstetricians who diagnose and treat fibroids with highly successful outcomes. Our facility is well-equipped with latest devices and technologies to perform myomectomy with highest level of precision and safety. We have successfully performed many of these surgeries and delivered excellent results even in complex cases.