Myomectomy is a procedure that removes fibroids and preserves the uterus. Sometimes this type of surgery is a safe and effective alternative to a hysterectomy, which is the surgical removal of the uterus.
Before having a myomectomy, you may need to prepare for surgery, which usually includes a monthly injection of Lupron for two to four months before surgery. Lupron inhibits the production of estrogen, causing fibroids to shrink. During this period, menstruation usually stops.
There are some advantages and disadvantages to using Lupron for preprocessing:
- It is expensive.
- It can cause menopausal symptoms such as hot flashes and night sweats.
- It may shrink some very small fibroids to the point that they cannot be seen during surgery, and these invisible fibroids may grow again, possibly requiring additional surgery.
A successful myomectomy should provide complete relief of all symptoms associated with fibroids. However, fibroids often grow back, so a hysterectomy is required later.
You can have repeat myomectomy safely, but each time increases your risk of pelvic adhesions, a type of postoperative scar tissue that can cause symptoms.
Complications are rare when a myomectomy is done correctly, but it’s important to understand the possible risks if you’re considering this procedure.
Possible complications include:
- blood loss
- Bowel obstruction (slowed bowel movement)
- intestinal obstruction
- advanced bowel obstruction
During surgery, the surgery may need to be converted to a hysterectomy. Some complications may require surgery.
Pregnancy is still possible after myomectomy, and some women who become pregnant after myomectomy may need to have a cesarean section because the uterine wall may weaken.
Before surgery, anesthesia is started and a catheter is inserted into the bladder to keep it empty during the procedure.
Another catheter is inserted into the uterus and dye is injected to stain the uterine cavity; this staining aids visualization to determine the location of the fibroids.
During your surgery:
- Drugs are injected into the first fibroids to be removed, temporarily stopping the blood supply to the fibroids so they can be removed with less risk of excessive bleeding and blood transfusions.
- Carefully close the space where the fibroids were removed. Each layer of tissue is sutured individually to prevent clots and other complications.
- This process is repeated as each fibroid is removed.
Dye also enters the fallopian tubes and can help determine if they are blocked or open. The fallopian tubes can also be repaired during this process.
All women undergoing minimally invasive myomectomy should be aware that a switch to traditional laparotomy or hysterectomy may be required while myomectomy is in progress.
Types of Myomectomy
There are several different myomectomy techniques. This surgery can use a number of different methods to access the fibroids from the vagina or abdomen. The type of myomectomy you will have depends on many factors, such as the size and location of the fibroids.
This is the most common type of myomectomy. Traditional myomectomy requires an abdominal incision of 5-7 inches, a hospital stay of less than 24 hours, and a recovery time of 6 to 8 weeks.
During this procedure, a small incision is usually made in the navel and the procedure is performed using a small laparoscope inserted through the abdominal wall into the uterus. This type of myomectomy offers the fastest recovery time.
Laparoscopic small incision myomectomy
This is a procedure that involves a small traditional abdominal incision to remove fibroids. This type of procedure can be used for fibroids of any size. Because the incision is only 4-5 cm, recovery is faster than with traditional myomectomy.
Laparoscopic myomectomy combined with vaginotomy
This is a procedure that involves making an incision in the vagina to remove large fibroids. This procedure does not close the defect left by the fibroids.
This is treated with the aid of a resection scope during hysteroscopy to treat submucosal fibroids. If intramural or subserosal fibroids are present, other types of myomectomy can be performed during this procedure.
More than 99% of fibroids are benign, but the chance of developing cancer is very small. After removal, your fibroids may be sent for a pathology evaluation to determine if it is cancerous.
What to ask your healthcare provider
Your healthcare provider should explain all possible fibroid treatment options before you make a decision.
Some questions you might want to ask:
- Why is your doctor recommending myomectomy now?
- What are the risks of deciding against myomectomy?
- How often does your doctor perform a hysterectomy?
- Which type of myomectomy is recommended for you? Why?
- Need a blood transfusion?
- Do you need preoperative treatment to shrink fibroids?
What should I know about fibroids surgery?