Myomectomy

Myomectomy is executed for the affected person affected by uterine fibroids, normally for the non-cancerous ones.

Myomectomy

Myomectomy is a surgical procedure to remove uterine fibroids (myomas) while keeping intact the healthy tissues of the uterus. These non-cancerous growths develop in the uterus during child-bearing years, but they can also occur at any age. The aim of myomectomy is to take out these symptom-causing fibroids and reconstruct the uterus. After this procedure, women will typically have a normally functioning uterus and could become pregnant in the future.

Fibroids often cause pain and excessive menstrual bleeding. They can also interfere with your ability to become pregnant. Doctors might recommend this surgery if fibroids are causing symptoms such as pelvic pain, heavy periods, irregular bleeding, and frequent urination. If uterine fibroids are the cause of infertility and one is planning to bear children, myomectomy is done so that the uterus can be kept functional.

How is it done?

Before the surgery, one needs to stop the intake of food and water at least for a few hours, according to the doctor's recommendation. Also, either general or local anaesthesia will be administered, based on the type of surgery to be done. Depending on the size, number, and location of the fibroids present, the surgeon may choose one of three surgical approaches to myomectomy - abdominal myomectomy, laparoscopic myomectomy, or hysteroscopic myomectomy.

Abdominal myomectomy

If the fibroids are large, numerous or deeply embedded in the uterus, then an abdominal or open myomectomy may be necessary. Here, the surgeon makes an open abdominal incision to access the uterus and remove fibroids. The incision, known as a "bikini cut”, is made through the skin on the lower abdomen. The fibroids are then removed from the walls of the uterus slowly and manually. Blood loss during the surgery may require a blood transfusion

Laparoscopic myomectomy

In this minimally invasive procedure, the surgeon accesses and removes fibroids through several small abdominal incisions. Four one-centimetre incisions are made in the lower abdomen - one at the navel, one above the pubic hair, and one near each hip. The abdominal cavity is then filled with carbon dioxide gas. A laparoscope is placed through an incision, allowing doctors to see the ovaries, fallopian tubes and uterus. Long instruments are then inserted through the other incisions and are used to remove the fibroids. This procedure may also be done robotically. The recovery from this type is faster than with abdominal myomectomy.

Hysteroscopic myomectomy

Women with submucosal fibroids (smaller fibroids that bulge significantly into the uterus) are eligible for a hysteroscopic myomectomy. Fibroids located within the uterine wall cannot be removed with this technique. The surgeon accesses and removes the fibroids using instruments inserted through the vagina and cervix into your uterus.

At discharge from the hospital, the doctor prescribes oral pain medications, and discusses the post-operative home care actions. There can be some vaginal spotting or staining, and cramping for a few days up to six weeks after the surgery, depending upon the type of procedure done. Typical recovery involves one to four days of resting at home. Continuing the prescribed medications and a strict keeping of the instructions for antibiotic intake also helps with a quick recovery.

What are the risks involved?

Myomectomy has a low complication rate. But, the procedure poses its own risks including

  • Risk due to anaesthesia
  • Excessive blood loss
  • Scar tissue
  • Future pregnancy or childbirth complications
  • Infection and damage to nearby organs
  • New fibroids that require another removal procedure

Myomectomy provides good scope for fertility improvement, giving good pregnancy outcomes within about a year of surgery. The suggested waiting time after surgery before attempting conception is about three to six months. This time period allows the uterus the required time to heal.