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Myomectomy

Myomectomy (my-o-MEK-tuh-mee) is a surgical procedure to remove uterine fibroids — also called leiomyomas (lie-o-my-O-muhs). These common noncancerous growths appear in the uterus, usually during childbearing years, but they can occur at any age.

The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes your entire uterus, a myomectomy removes only the fibroids and leaves your uterus intact.

Women who undergo myomectomy report improvement in fibroid symptoms, including heavy menstrual bleeding and pelvic pressure.

Myomectomy is a type of surgery used to remove uterine fibroids. Your doctor might recommend this surgery if your fibroids are causing symptoms such as:

  • pelvic pain
  • heavy periods
  • irregular bleeding
  • frequent urination

A myomectomy can be done one of three ways:

  • Abdominal myomectomy lets your surgeon removes your fibroids through an open surgical cut in your lower belly.
  • Laparoscopic myomectomy allows your surgeon to remove your fibroids through several small incisions. This may be done robotically. It’s less invasive and recovery is faster than with abdominal myomectomy.
  • Hysteroscopic myomectomy requires your surgeon to use a special scope to remove your fibroids through your vagina and cervix.

Risks Of Myomectomy

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

  • Excessive blood loss. Many women already have low blood counts (anemia) due to heavy menstrual bleeding, so they're at a higher risk of problems due to blood loss. Your doctor may suggest ways to build up your blood count before surgery.

    During myomectomy, surgeons take extra steps to avoid excessive bleeding, including blocking flow from the uterine arteries and injecting medications around fibroids to cause blood vessels to clamp down.

    Studies suggest blood loss is similar between a myomectomy and hysterectomy. Also, with both, blood loss is higher with a larger uterus.

  • Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Outside the uterus, adhesions could entangle nearby structures and lead to a blocked fallopian tube or a trapped loop of intestine.

    Rarely, adhesions may form within the uterus and lead to light menstrual periods and difficulties with fertility (Asherman's syndrome). Laparoscopic myomectomy may result in fewer adhesions than abdominal myomectomy (laparotomy).

  • Pregnancy or childbirth complications. A myomectomy can increase certain risks during delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery (C-section) to avoid rupture of the uterus during labor, a very rare complication of pregnancy. Fibroids themselves are also associated with pregnancy complications.
  • Rare chance of hysterectomy. Rarely, the surgeon must remove the uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids.
  • Rare chance of spreading a cancerous tumor. Rarely, a cancerous tumor can be mistaken for a fibroid. Taking out the tumor, especially if it's broken into little pieces to remove through a small incision, can lead to spread of the cancer. The risk of this happening increases after menopause and as women age.

How you prepare

1. Food and medications

You'll need to fast — stop eating or drinking anything — in the hours before your surgery. Follow your doctor's recommendation on the specific number of hours.

If you're on medications, ask your doctor if you should change your usual medication routine in the days before surgery. Tell your doctor about any over-the-counter medications, vitamins or other dietary supplements that you're taking.

Ask your doctor about the type of anesthesia you may receive:

  • General anesthesia, which means you're asleep during surgery, is used for abdominal, laparoscopic, robotic and some hysteroscopic myomectomies
  • Spinal anesthesia, where medication is injected into your spinal canal to numb the nerves in the lower half of your body, is used for certain hysteroscopic myomectomies.

Finally, discuss with your doctor pain medication and how it will likely be given.

2. Other preparations

Whether you stay in the hospital for just part of the day or overnight depends on the type of procedure you have. Abdominal (open) myomectomy usually requires a hospital stay of two to three days. In most cases, laparoscopic or robotic myomectomy only requires an overnight stay. Hysteroscopic myomectomy is often done with no overnight hospital stay.

Your facility may require that you have someone accompany you on the day of surgery. Make sure you have someone lined up to help with transportation and to be supportive.

Source: https://www.mayoclinic.org/tests-procedures/myomectomy/about/pac-20384710




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