Myomectomy is a surgical procedure to remove uterine fibroids, also called smooth muscle tumors. These common non-cancerous tumors appear in the uterus. Uterine fibroids usually develop during childbearing age, but they can occur at any age.
The goal of myomectomy is to eliminate the fibroids causing the symptoms and reconstruct the uterus. Unlike hysterectomy, which completely removes the uterus, myomectomy removes only fibroids and leaves the uterus.
Women who underwent mastectomy reported improvement in symptoms of fibroids, including reduced menstrual bleeding and pelvic pressure.
Your doctor may recommend a mastectomy if the symptoms of fibroids are causing discomfort or preventing you from performing your daily activities.
It is better to undergo a myomectomy instead of a hysterectomy to remove uterine fibroids if:
- You are planning to have children
- Your doctor suspects that uterine fibroids may interfere with your fertility
- You don’t want to remove your uterus
Risks of this procedure
- Excessive blood loss. Many women with uterine fibroids have anemia due to heavy menstrual bleeding and are therefore more likely to have problems due to blood loss.
- Scar tissue. Surgical incisions in the uterus to remove the fibroid can lead to adhesions – strips of scar tissue that may form after surgery. Laparoscopic myomectomy may result in fewer adhesions compared with abdominal myomectomy.
- Complications during childbirth. Myomectomy can increase some of the risks during childbirth if you become pregnant. If the surgeon had to make a deep surgical incision in the uterine wall, the doctor, who will take charge of your next pregnancy, may recommend a cesarean delivery to avoid uterine rupture during labor, which is a very rare complication of pregnancy.
- A rare chance of hysterectomy. In rare cases, the surgeon must remove the uterus if the bleeding is uncontrollable or if other problems exist in addition to the fibroids.
- A rare chance of spreading a cancerous tumor. In rare cases, carcinoma and fibroids may be confused. Removal of the tumor, especially if it is divided into small portions to be removed through a small surgical incision, can lead to the spread of cancer. The risk of this occurring increases after menopause and as women get older.
Ways to prevent the risks and complications of myomectomy
To reduce the risk of myomectomy, your doctor may recommend:
- Iron and vitamins supplement. If you have iron-deficiency anemia due to heavy menstrual periods, your doctor may recommend iron and vitamin supplements to allow the number of blood cells to increase before surgery.
- Hormone therapy. Another strategy to treat anemia is preoperative hormonal therapy. Your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist or may give you birth control pills, or other hormonal treatments to stop or reduce menstrual bleeding.
- Treatment to shrink fibroids. Some hormonal treatments, such as GnRH agonist therapy sessions, can shrink your fibroids and uterus enough to allow your surgeon to use a minimally invasive surgical approach – such as a smaller horizontal incision rather than a vertical incision, or an endoscopic procedure rather than an open procedure.
Types of myomectomy
In abdominal myomectomy, the surgeon makes an incision in the abdomen to reach the uterus and remove uterine fibroids. To remove fibroids, the surgeon usually makes a low horizontal incision in the bikini area; however, vertical incision is required for larger uteruses.
Laparoscopic or robotic myomectomy
In these minimally invasive procedures, the surgeon can reach and remove uterine fibroids through several small incisions in the abdomen.
- Laparoscopic myomectomy. The surgeon makes a small incision in or near the navel. Then a laparoscope inserted into the abdomen. The surgeon performs the procedure by inserting instruments through other small incisions in the abdominal wall.
- Robotic Myomectomy. The surgeon inserts instruments through small incisions similar to those in laparoscopic myomectomy, and then controls the movement of the instruments from a separate unit.
The surgeon inserts a small, lighted instrument through the vagina and cervix into the uterus. A wire loop endoscope is used to cut tissues using electricity.
A transparent fluid, usually a sterile salt solution, is injected into the uterus to expand the uterine cavity and allow the uterine walls to be examined.
The surgeon removes pieces from the fibroid using a special instrument and removes the pieces from the uterus until the fibroid is completely removed. Sometimes large fibroids cannot be completely removed in one surgery, and a second surgery is required.
After the procedure
Upon discharge from the hospital, your doctor will prescribe pain medication, tell you how to take care of yourself and discuss the limitations of your diet and activities. You can expect some vaginal bleeding for several days up to six weeks, depending on the type of procedure that was performed.