A myomectomy describes a surgical procedure involving the removal of uterine fibroids while preserving the uterus. Fibroids are noncancerous growths can that develop in or on the walls of the uterus.Uterine fibroids, also known as leiomyomas and myomas, are the most commonTrusted Source noncancerous, or benign, tumors in females of childbearing age. Fibroids refer to growths of smooth muscle cells and connective tissue that may be present in or on the walls of the uterus.A person may have one or multiple fibroids, which can vary in size. Some people may not experience symptoms, while others have heavy and painful periods. Fibroids become more common as females age, and between 20–80%Trusted Source of females develop them by the age of 50 years. While most uterine fibroids are noncancerous, they can be cancerous in rare cases, where doctors call them leiomyosarcomas.If a fibroid is potentially affecting a person’s fertility, causing symptoms, or has features that may suggest malignancy, surgical removal, or a myomectomy, may be an appropriate treatment.In this article, we will discuss the myomectomy procedure, including who may be a suitable candidate, how to prepare for the surgery, and what the operation may involve.
A myomectomy refers to a surgical operation that aims to remove fibroids while preserving the uterus. As such, it may be suitable for those experiencing symptoms of fibroids and those who may consider having children in the future.Certain fibroids do not always cause symptoms and often do not require treatment. However, a person may need a myomectomy if their fibroids are causing symptoms, such as:
longer, more frequent, or heavy periods
cramps
anemia
pelvic, abdominal, or lower back pain
pain during sex
difficulty urinating
constipation
rectal pain or difficulty passing stools
pregnancy loss
infertility
an enlarged uterus and abdomen
Someone with fibroids who wishes to get pregnant in the future may prefer a myomectomy. This is because the procedure leaves the uterus in place, unlike a hysterectomy, which involves removing it.
Before the procedure, a doctor may request additional tests. Some of these may includeTrusted Source:
blood tests
an echocardiogram, which produces an image of the heart using sound waves
imaging scans for visualization of the uterus and fibroids
A person may also receive drugs that shrinkTrusted Source the fibroids before surgery and lower the risk of bleeding during the procedure. These medications include gonadotropin-releasing hormone agonists, such as leuprolide acetate, and selective progesterone receptor modulators, such as ulipristal acetate.The length of the operation will depend on the type of procedure the doctor performs and how many fibroids they remove. A doctor can provide more information. A person can also ask the medical team any questions about the procedure, including its risks and benefits.
A person will receive general anesthesia before the operation to put them to sleepTrusted Source and prevent them from feeling pain during the procedure. A medical professional can perform a myomectomy in different ways. This will depend on the size, location, the number of fibroids present, and whether the person is suitable for a particular kind of myomectomy.
Abdominal myomectomy
In an abdominal myomectomy, a surgeon will perform different incisions depending on the size and location of the fibroids and the person’s body. For example, the surgeon may cut into the skin of the lower abdomen along the pubic hairline. They will cut through layers of the abdominal wall and enter the abdominal cavity, the location of the uterus. A surgeon can then remove the fibroids and use stitches to close the wound.A surgeon may recommend this type of surgery for a person with numerous or very large fibroids. Additionally, they may recommend this procedure for someone with fibroids between the uterine muscles or the outer uterine wall.
Laparoscopic myomectomy
A laparoscopic myomectomy involves putting a small camera through the belly button. A surgeon will make additional smaller cuts in the abdomen to pass surgical instruments through and remove the fibroids. They will then close the wound using sutures.This procedure is minimally invasive, as it avoids larger cuts, such as those from abdominal myomectomy. This type of myomectomy is suitable for people with fewer fibroids on the outer uterine wall.
This myomectomy type involves inserting a hysteroscope, a camera with an attached light, through the vagina and cervix and into the uterus. A surgeon can then use surgical instruments, such as a wire or loop, to remove the fibroids inside the uterus.This type of myomectomy is only suitable for a person with fibroids inside the uterine hysteroscope or just beneath the inner lining of the uterus.https://youtu.be/WOogprU-0qM
Robotic myomectomy
This procedure combines high-definition 3D magnification, robotic technology, and small instruments to remove fibroids.A surgeon will make several small incisions in the abdomen. These cuts will allow the robotic arms and instruments to enter the uterus and remove the fibroids. Depending on the size of the fibroid, the surgeon may need to break the fibroid down into smaller pieces to remove it from the abdomen.A 2018 retrospective study found that a robotic myomectomy was suitable for removing large uterine fibroids and had a low complication rate. Additionally, this method uses a minimally invasive approach, generally resulting in a shorter hospital stay and quicker recovery.
The overall recovery time for a myomectomy depends on the type of procedure. Typically, most people can go home after a few days and return to their typical activities after a few weeks. The following are how long a person will need to stay in the hospital and reduce their typical activities following a myomectomy: A person who undergoes an abdominal myomectomy may need to stay in the hospital for 1–2 nights and reduce their activity levels for 6–8 weeks. For laparoscopic myomectomies, an individual may need to spend 1 night in the hospital and reduce their activity for 4 weeks. For hysteroscopic myomectomies, someone may need to stay in the hospital for 1–2 hours but usually goes home the same day. Recovery time typically takes 1–2 days. A robotic myomectomy may involve up to 1 night in the hospital and reduced activity for 4 weeks. ERAS procedures can offer same day discharge with much quicker recovery times. Recovery is generally quicker for less invasive myomectomy procedures and operations involving the removal of smaller and easily accessible fibroids. If a person is planning to try for pregnancy, they should consult their doctor about when it would be safe to resume sexual activity, attempt to conceive, or begin fertility treatment.
A myomectomy may be beneficial in reducing some of the symptoms of fibroids. For example, a person may experienceTrusted Source less menstrual bleeding and reducedTrusted Source pelvic pain after the procedure. A myomectomy may also help improve fertility and decrease the risk of pregnancy loss.While removing fibroids is an effective procedure, a surgeon may not be able to remove them all in a single procedure. In such cases, additional surgery may be necessary to remove those that remain. It is also possible that fibroids can recur, or new fibroids can grow, which may also require removing.
As with any surgery, a myomectomy can carry risks, which may depend on the procedure. For example, potential risks of a laparoscopic myomectomy may includeTrusted Source:
injury to the uterus, or uterine perforation
injury to other organs during breaking down of fibroids
bleeding
pooling of blood in the outer layer of the uterus
incomplete removal of the fibroids
infection
venous air embolism
There may also be a riskTrusted Source of a rupture in the uterus during pregnancy following a myomectomy. A person who undergoes this procedure may later require a cesarean delivery during pregnancy if their rupture risk is higher.
A myomectomy is a surgical procedure that aims to remove fibroids from the uterus while preserving it. A person who experiences fibroid symptoms and may want children in the future could be a suitable candidate for a myomectomy.The types of myomectomy procedures available include abdominal, laparoscopic, hysteroscopic, and robotic myomectomy. A doctor will decide the most appropriate approach. The recovery time will depend on the type of procedure a person has but will likely take a few weeks.While myomectomies may help with fibroid symptoms, a person may still develop new fibroids after surgery. In such cases, they may require further surgery.
