Myomectomy

What is Myomectomy?

Myomectomy is a surgical procedure to remove uterine leiomyomas (fibroids), or benign non-cancerous growths of the uterus. The majority of women with uterine fibroids may have no symptoms, in which case fibroids do not require treatment. However, symptoms often associated with the presence of fibroids include heavy or prolonged menstrual bleeding, pelvic pressure or pain, frequent urination, difficulty emptying bladder, constipation, backache or leg pain, infertility, or reproductive problems.

Myomectomy is the treatment of choice in women with fibroids who are planning to have children in the future. Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.

Preparing for the Surgery

Before your surgery, hormones to stop heavy bleeding or gonadotropin-releasing hormone analogue (GnRH-a) therapy to shrink the uterine fibroids, thus reducing the risk of excessive bleeding or need for large incisions, may be recommended.

Indications for Myomectomy

A myomectomy is a treatment option if you have anemia and pain or pressure not relieved with medications. Myomectomy is also done if the fibroids have changed the uterus so as to cause infertility or repeated miscarriages as this method improves your chances of becoming pregnant even after the procedure. After myomectomy, your pelvic pain and bleeding from fibroids are reduced and your chances of having a baby are improved. If the fibroids are large and are more in number, they can re-grow after surgery.

Myomectomy Procedure

Depending on the size, location, and a number of fibroids, your surgeon may choose one of three surgical approaches to remove the fibroids:

Hysteroscopy

This is an outpatient surgical procedure and is performed under general or intravenous (IV) anesthesia. Your doctor uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Your doctor can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Your doctor may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that have not gone deep within the wall of the uterus can be removed using this technique.

Laparoscopy/Robotic Surgery

A laparoscopic or robotic) myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached with a camera is used. A small incision is usually made below the navel and a laparoscope is inserted through this incision. Carbon dioxide gas is used to insufflate the abdominal cavity to create more space to work. Your surgeon identifies and removes the fibroids. During the procedure, tissue samples can also be taken for biopsy.

Laparotomy

A laparotomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall your doctor may opt for laparotomy. Urinary or bladder problems can be corrected using laparotomy.

Complications

The possible complications of myomectomy include infection, scar tissue formation, damage to the bladder or bowel, and rupture of the uterine scars in late pregnancy or during labor. Rarely, a myomectomy causes uterine scarring that can lead to infertility.

Because fibroids can grow back, those women who are planning to become pregnant in the future must try to conceive as early as 4-6 months after the myomectomy procedure. Following surgery, your doctor will advise you to wait for 4 to 6 months to conceive until the uterus heals.

The incisions made in the wall of the uterus to remove fibroids may cause placental problems and improper functioning of the uterus during labor may need a cesarean delivery. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.