Myomectomy is a surgical procedure in which fibroid (benign or non-cancerous tumors) is removed. Gynecologists use it to treat uterine fibroids. This procedure allows a woman to keep her uterus and have children later.
The procedure may involve different techniques, depending on the size of the fibroid. Recovery time varies according to the actual procedure performed. But let’s find out more on myomectomy.
What Is a Myomectomy?
Although myomectomy is the surgical removal of fibroids from the uterus, it is called a myomectomy because the technical term for fibroids is uterine leiomyomas. Since fibroids can interfere with conception, a myomectomy may improve the chances of conception once healing is complete. Surgical removal of fibroids is optional in many cases. The physician is more likely to recommend removal in one of the below situations:
- Fibroid causes pressure or pain;
- Abnormal heavy bleeding
- Conception is a problem.
Pregnancy can cause fibroids to increase in size, which can cause pain or other problems. In most cases, when fibroids need to be removed, they are large or growing in locations where they interfere with normal physiological functioning. The surgery may be performed through laparotomy, laparoscopy, or sometimes hysteroscopy. Also, the surgeon may use robotic assistance with laparoscopy. The robotic and laparoscopic procedures are less invasive than a laparotomy and the recovery time is significantly shorter. Although not recommended due to bleeding and risks, a myomectomy sometimes may need to be performed during a cesarean section.
Types of Myomectomies
Although a myomectomy is a specific procedure, the surgery may be performed using one of several different techniques. Each offers certain advantages.
- Laparoscopy: In this procedure a device very much like a slender telescope is inserted through the navel. Several small incisions are made between the belly button and pubic bone. The laparoscope allows the surgeon to see the surgical area while the other incisions allow small instruments to be inserted. The fibroid can be removed and then shredded into smaller pieces inside the body to allow it to be brought out.
- Hysteroscopy: When fibroid is completely or primarily inside the cavity of the uterus, the surgeon may perform a hysteroscopy. The surgeon is using a device that is inserted through the cervix. This way, he/she is able to use high-frequency energy and or a small bladed instrument to excise the fibroid. No incisions are necessary.
- Laparotomy: This is a more typical surgical procedure, with a large incision in the abdomen. The incision may be made sideways just above the pubic area to minimize scarring or vertically in the middle of the abdomen. A laparotomy allows greater access to larger fibroids for removal.
Who Needs a Myomectomy?
Uterine fibroids are the only reason to have a myomectomy. Small fibroids are fairly common and may not cause any problems or only occasional, minor symptoms. In that case, the risks of a myomectomy will probably outweigh the benefits. Some women prefer non-surgical options or have other conditions that increase the risk of complications. In a woman who doesn’t want to have children or who has already had all the children she planned on, the presence of fibroid is not enough of a reason to undergo surgery, symptoms must be significant enough to cause problems for her.
Fibroids always gets smaller after menopause. Usually they shrink about 30% from their original size. Many women who are close to that stage of their lives decide to wait it out or try non-surgical therapies to minimize the symptoms, like bleeding or cramps, such as hormones. Women who opt for a myomectomy surgery are usually younger and want children and/or have symptoms that interfere with their daily lives. A myomectomy removes the fibroids, which are the source of pain because of their increasing size or location in the uterus. If the fibroid causes bleeding, a myomectomy may be necessary to stop the bleeding, even if a woman has no other symptoms.
Risks Involving a Myomectomy
Like all surgeries, a myomectomy has risks. These include:
- Fibroid recurrence; this happens in up to 50% women who have myomectomies.
- Infections in the uterus, fallopian tubes or ovaries, as well as an infection in the surgical site itself.
- Scar tissue around the uterus ore inside the uterine muscle.
- Infertility resulting from scar tissue (this is not common).
- Injuries to the bladder or bowel, including bowel obstruction.
- Severe bleeding.
- Uterine scars may rupture during pregnancy or delivery.
Recovery from a Myomectomy
The different types of myomectomy procedures have the greatest effect on the recovery process after surgery.
- Hysteroscopy: Outpatient procedure, with recovery period of a few days to one week. Doctors recommend postoperative oral pain medications. No vigorous exercise or heavy lifting until the patient recovers. No incisions or bandages; a sanitary pad is used for vaginal bleeding.
- Laparoscopy and Robotic Laparoscopy: Also outpatient or short overnight stay procedure. Oral pain medications also fit here. Recovery period one to two weeks. No vigorous exercise or heavy lifting until fully recovered. Small bandages or band-aids over very short incisions. If there is vaginal bleeding, use a sanitary pad.
- Laparotomy: Inpatient procedure with a stay of two to four days. Intravenous pain medications used initially, then patient switches to oral pain medications. Recovery period of four to six weeks. No heavy lifting or vigorous exercise until fully recovered. Medium bandage over abdominal incision; can be changed if soiled or there is bleeding. A sanitary pad is used for vaginal drainage.
Alternatives to a Myomectomy
There are two non-surgical approaches to treating fibroid.
- Uterine artery embolization (UAE) or uterine fibroid embolization (UFE) is a procedure in which small particles are injected into the blood vessels (arteries) that feed the fibroid. The injection cuts off the blood supply and the fibroid shrinks significantly in almost all cases.
- Medical management with pain medications and hormones can help relieve symptoms. Depot lupron injection will temporarily shrink the fibroid. But they cannot be used long-term due to the risk of premature menopause and osteoporosis. Once the hormones are stopped fibroid regrows.
To Sum It Up
Uterine fibroids can be painful and cause distress. Women who suffer from this condition do have alternatives for treatment that can help preserve fertility and allow childbearing afterwards. If you believe you have uterine fibroids, consult a medical professional.
Have you have treatment for uterine fibroid? If so, please share your experiences.
The images are from pixabay.com.