What is Myomectomy?

Myomectomy is a type of surgery used for removing uterine fibroids. The doctor might recommend this surgery if the fibroids are causing symptoms such as:

• Pelvic pain
• Heavy periods
• Irregular bleeding
• Frequent urination

A myomectomy can be done in one of these three ways:

• Abdominal myomectomy lets the surgeon removes the fibroids through an open surgical cut in the patient’s lower belly.
• Laparoscopic myomectomy allows the surgeon to remove the fibroids through small incisions. This may be performed robotically. It’s less invasive and recovery is much faster as compared to abdominal myomectomy.
• Hysteroscopic myomectomy allows the surgeon to remove the fibroids through the vagina and cervix with the help of a special scope

Procedure:

Abdominal myomectomy

In abdominal myomectomy, the surgeon makes an open abdominal incision for accessing the uterus and remove fibroids. The surgeon enters the pelvic cavity with the help of one or two incisions:

• A horizontal bikini-line incision that runs about an inch above the patient’s pubic bone. This incision follows the natural skin lines, so it generally results in a thinner scar and thus causes less pain than a vertical incision does. It may be only 3 to 4 inches. Because it restricts the surgeon's access to the pelvic cavity, a bikini-line incision may not be preferable if the patient has a large fibroid.
• A vertical incision starts from the middle of the abdomen and extends from just below the patient’s navel to just above their pubic bone. This provides the surgeon with greater access to the uterus than a horizontal incision does and results in less bleeding. It is rarely used unless the uterus is so big that it extends up past the patient’s navel.

Laparoscopic or robotic myomectomy

In laparoscopic or robotic myomectomy, the surgeon removes fibroids through several small abdominal incisions.

• Laparoscopic myomectomy. The surgeon makes a small incision in or near the belly button. Then the surgeon inserts a laparoscope, a narrow tube fitted with a camera into the patient’s abdomen. The surgeon performs the surgery with the help of instruments that are inserted through other small incisions in the abdominal wall.
• Robotic myomectomy. Instruments are inserted through small incisions which is similar to that in a laparoscopic myomectomy, and the surgeon controls the movement of instruments with the help of a separate console.

Hysteroscopic myomectomy

To treat fibroids that bulge significantly into the patient’s uterine cavity, the surgeon might suggest hysteroscopic myomectomy. The surgeon accesses and removes fibroids using instruments which are inserted through the patient’s vagina and cervix and into their uterus.

A hysteroscopic myomectomy follows the following process:

• The surgeon place a small, lighted instrument called a resectoscope because it cuts tissue with the help of electricity or a laser beam through the vagina and cervix and into the patient’s uterus.
• A clear liquid, usually a sterile salt solution, is inserted into the patient’s uterus to expand their uterine cavity and thus allowing the examination of the uterine walls.
• With the help of resectoscope, the surgeon shaves pieces from the fibroid until it aligns with the surface of the uterine cavity.
• The removed fibroid tissue washes out by the clear liquid that's used for expanding the uterus during the procedure.

After the procedure

At discharge from the hospital, the doctor may prescribe oral pain medication, tells the patient how to care for themselves, and discusses restrictions on their diet and activities. The patient can have some vaginal spotting or staining for a few days up to six weeks, this depends on the type of procedure they had.

Results

Outcomes from myomectomy might include the following:

• Symptom relief: After myomectomy surgery, most women experience relief from excessive menstrual bleeding and pelvic pain and pressure.
• Fertility improvement: Removing submucosal fibroids by hysteroscopic myomectomy can help in improving the fertility and pregnancy in women. After a myomectomy, the patient must wait at least three months before attempting conception to allow the uterus enough healing time.

How soon will I recover?

The patient will experience some pain after their surgery. The doctor can provide medication for treating any discomfort. The patient can return to their day to day activities, but that generally depends on the type of procedure that the patient has undergone. Open surgery has one of the longest recovery times.

Recovery times for each procedure are as follows:

• Abdominal Myomectomy: Four to Six Weeks
• Laparoscopic Myomectomy: Two to Four Weeks
• Hysteroscopic Myomectomy: Two to Three Days

Patients are advised not to lift anything heavy or exercise strenuously until their incisions have fully healed. Before returning to activities the patient must consult their doctor. The patient may have to wait up to six weeks before having sex. If the patient wants to get pregnant, they must ask their doctor. The patient might need to wait for six months to allow their uterus to get fully healed.

What are the risks involved?

Myomectomy has a low complication rate. Still, the procedure has a unique set of challenges. Risks of myomectomy may include:

• Excessive blood loss: Many women have low blood counts because of heavy menstrual bleeding, so this may pose a higher risk of problems to the patient due to blood loss. The doctor may suggest ways to build up the blood count before the surgery. During myomectomy, the surgeon takes extra precaution for avoiding excessive of bleeding, including blocking flow from the uterine arteries and injecting medications around fibroids which causes blood vessels to clamp down. Studies have suggested blood loss is similar between myomectomy and hysterectomy.
• Scar tissue: Incisions into the uterus is used for removing fibroids which can lead to adhesions, bands of scar tissue that may develop after surgery. Outside the uterus, adhesions could entangle nearby structures and can result in blockage of the fallopian tube or a trapped loop of intestine. Rarely, adhesions form within the uterus and this can lead to light menstrual periods and results in difficult fertility. Laparoscopic myomectomy may result in fewer adhesions as compared to abdominal myomectomy.
• Pregnancy or childbirth complications: A myomectomy can increase some risks during delivery if the patient has become pregnant. If the surgeon had to make a deep incision in the uterine wall, the doctor who manages the patient’s subsequent pregnancy may recommend cesarean delivery for avoiding the rupture of the uterus during labor.
• Rare chance of hysterectomy: It is very rare, the surgeon removes the uterus if bleeding is uncontrollable or other abnormalities are found in along with fibroids.
• Rare chance of spreading a cancerous tumor: In rarest of the rare cases, a cancerous tumor can be mistaken for a fibroid. Taking out the tumor, especially if it is broken into little pieces, by removing the tumor through a small incision, can lead to the spread of cancer. The risk of this happening increases after menopause and as the women age.