Myomectomy is a surgical procedure used to remove fibroids (also called myomas) from the uterus. Fibroids are non-cancerous (benign) growths that develop in or on the uterus. While fibroids are often asymptomatic, they can cause symptoms such as heavy menstrual bleeding, pelvic pain, frequent urination, or difficulty getting pregnant. A myomectomy is often recommended for women who wish to preserve their uterus, particularly if they are experiencing symptoms or have fertility concerns
Types of Myomectomy
The procedure can be performed using several different techniques, depending on the size, location, and number of fibroids. The main types of myomectomy are:
- Abdominal Myomectomy (Open Myomectomy)
- Procedure: This is the most traditional approach, involving a large incision in the abdomen (similar to a cesarean section) to access the uterus and remove the fibroids.
- Indications: Recommended for large or multiple fibroids or if the fibroids are deeply embedded in the uterine wall.
- Recovery: This is a more invasive surgery, and recovery time typically takes 4 to 6 weeks.
- Laparoscopic Myomectomy (Minimally Invasive)
- Procedure: Also known as keyhole surgery, this method uses small incisions and a camera (laparoscope) to guide the removal of fibroids. It is less invasive and is usually done when fibroids are located on the outer wall of the uterus.
- Indications: Suitable for small fibroids or when the fibroids are located on the outer surface of the uterus.
- Recovery: Recovery time is generally shorter than for an abdominal myomectomy, often around 1 to 2 weeks.
- Hysteroscopic Myomectomy (Through the Cervix)
- Procedure: This method is used for fibroids located inside the uterus (submucosal fibroids). The surgeon uses a thin, lighted tube (hysteroscope) inserted through the cervix to access and remove the fibroids.
- Indications: Best for fibroids that are inside the uterine cavity (submucosal), which can cause heavy bleeding and other symptoms.
- Recovery: This is a minimally invasive procedure with a quicker recovery time, usually a few days to a week.
- Robot-Assisted Myomectomy
- Procedure: In this advanced version of laparoscopic surgery, the surgeon uses robotic technology to perform the surgery with greater precision and control. The robot is controlled by the surgeon from a console.
- Indications: Suitable for fibroids that are difficult to access or remove using traditional laparoscopic methods.
- Recovery: Similar to laparoscopic myomectomy, recovery time is shorter compared to abdominal surgery.
Indications for Myomectomy
A myomectomy is typically recommended for women who:
- Have symptoms caused by fibroids, such as:
- Heavy menstrual bleeding or prolonged periods.
- Pelvic pain or pressure.
- Urinary frequency or incontinence due to the fibroid pressing on the bladder.
- Constipation or difficulty with bowel movements because of pressure on the rectum.
- Are trying to conceive: Fibroids can sometimes interfere with fertility by blocking the fallopian tubes, altering the shape of the uterine cavity, or preventing implantation. A myomectomy can improve fertility outcomes in some women.
- Do not wish to have a hysterectomy (removal of the uterus), but need relief from symptoms caused by fibroids.
Benefits of Myomectomy
- Uterus preservation: The primary advantage of myomectomy over hysterectomy is that the uterus is preserved, which is important for women who wish to retain fertility or avoid the emotional and physical impact of having their uterus removed.
- Symptom relief: Most women experience significant relief from the symptoms of fibroids, such as heavy bleeding, pelvic pain, and pressure.
- Improved fertility: In some cases, removing fibroids can increase a woman’s chances of conceiving.
Risks and Complications
As with any surgery, there are risks associated with myomectomy, including:
- Infection: Any surgical procedure carries the risk of infection.
- Bleeding: Heavy bleeding can occur, and in rare cases, a blood transfusion may be necessary.
- Scar tissue (adhesions): Scar tissue may form inside the abdomen or uterus after surgery, which can sometimes cause pain or fertility problems.
- Injury to surrounding organs: During surgery, there is a small risk of injury to nearby organs, such as the bladder, bowel, or ureters (the tubes that carry urine from the kidneys to the bladder).
- Recurrence of fibroids: Fibroids can recur after myomectomy, particularly if the woman has a family history or other risk factors. In some cases, additional surgery may be required.
- Premature birth or miscarriage: Women who have a myomectomy may have an increased risk of complications during pregnancy, such as preterm labor or miscarriage, especially if the fibroids were large or if the surgery involved deep cuts into the uterine wall.
Recovery and Aftercare
- Abdominal Myomectomy: Recovery takes longer for open surgery, typically 4 to 6 weeks. Patients will need to avoid strenuous activity and heavy lifting during this time. Pain is usually managed with prescribed medications.
- Laparoscopic or Hysteroscopic Myomectomy: Recovery is quicker, often around 1 to 2 weeks, but patients should still avoid heavy activity and follow their doctor’s instructions for post-operative care.
- Follow-up: Regular follow-up visits will be scheduled to monitor the healing process and ensure there are no complications.
- Fertility after Myomectomy: Women who undergo myomectomy for fertility reasons may be advised to wait several months after surgery before trying to conceive, depending on their individual case and the type of surgery performed.
Alternatives to Myomectomy
While myomectomy is a common treatment for symptomatic fibroids, there are other treatment options, including:
- Hysterectomy: The removal of the uterus, which is a permanent solution to fibroids but eliminates the possibility of future pregnancies.
- Uterine Artery Embolization (UAE): A minimally invasive procedure in which the blood vessels supplying the fibroids are blocked, causing the fibroids to shrink.
- MRI-guided Focused Ultrasound: A non-invasive technique that uses focused ultrasound waves to destroy fibroids.
- Medications: Hormonal treatments or other medications may help control symptoms but do not remove the fibroids.
Conclusion
Myomectomy is an effective surgical treatment for fibroids that preserves the uterus and can provide relief from symptoms like heavy bleeding, pelvic pain, and infertility. It is a good option for women who wish to maintain fertility or avoid a hysterectomy. The procedure is generally safe, but, like any surgery, it carries risks and requires proper post-operative care for optimal recovery. If you’re considering a myomectomy, it’s important to consult with a gynecologist or reproductive specialist to discuss the best approach based on your specific condition and goals.