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Sometimes, non-cancerous growths, called uterine fibroids in medical terms appear in the uterus of women, especially during the childbearing years, though they may occur at any age. To remove these fibroids, ‘Myomectomy’, a surgical procedure is recommended by doctors to remove uterine fibroids. Unlike hysterectomy, where the entire uterus is completely removed, myomectomy removes only the uterine fibroids and the uterus is left untouched.
Myomectomy is recommended by surgeons when the fibroids cause problems or interfere with your regular normal activities. The reasons why myomectomy is performed are when:
1.You plan to conceive
2.Your doctor suspects that uterine fibroids might interfere with your fertility
3.You want to keep your uterus
The surgeon aims to take out symptom-causing fibroids and reconstruct the uterus while myomectomy surgery is done. It is seen that women who had undergone myomectomy surgery had improvement in fibroid symptoms, including decreased heavy menstrual bleeding and pelvic pressure.
How would you prepare
Food and medications
You need to fast — stop eating or drinking anything in the hours before the surgery. Follow your doctor’s advice on the specific number of hours need to be maintained.
If you’re on medications, take the advice of the doctor and the routine that may or may not be altered. Consult with your doctor regarding any over-the-counter medications, vitamins or other dietary supplements you are taking.
You will need anaesthesia, depending on the surgical procedure:
General anaesthesia: General anaesthesia is used for laparoscopic myomectomy and abdominal myomectomy; though, it is also used for hysteroscopic myomectomy, sometimes.
Monitored anaesthesia care (MAC): With this type of anaesthesia, no tube is placed in your throat, unlike general anaesthesia. MAC is often used for hysteroscopic myomectomy, as it is a less invasive procedure.
Sometimes other types of anaesthesia such as a spinal or local is used as per doctor’s advice. Also talk to your doctor about pain medication and how it would be implemented upon you.
Other preparations
Whether you stay in the hospital for few hours or spend a full day, depends on the type of surgical procedure your doctor performs. For abdominal myomectomy (laparotomy) it is usually a done in one or two days and as such you need to stay for a day or two in the hospital. In most cases, laparoscopic or robotic myomectomy is done outpatient or with only one day stay. And in case of hysteroscopic myomectomy usually no overnight hospital stay is required. But whatever it be, during the time of discharge from the hospital you need someone to help you with transportation and other types of requirements.
Surgical approaches
Your surgeon may choose one of the three surgical approaches to myomectomy, depending on the size, number and location of your fibroids.
Abdominal myomectomy
In this procedure, the surgeon makes an open abdominal incision to access your uterus and remove the fibroids. Your surgeon generally prefers to make a low, horizontal incision, if possible. Vertical incisions are needed for larger uteruses.
Laparoscopic or robotic myomectomy
For laparoscopic or robotic myomectomy, in which both minimally invasive procedures are done, the surgeon accesses and removes fibroids using several small abdominal incisions.
Compared with women who have a laparotomy, women who undergo laparoscopy have lesser blood loss, shorter hospital stays, faster recovery, and lower rates of complications. In case of robotic surgery you may take longer time and is generally expensive.
1.Laparoscopic myomectomy: In this procedure, the surgeon makes a small incision in or near your bellybutton. Then a laparoscope, a narrow tube fitted with a camera is inserted into your abdomen. The surgeon performs the surgery with instruments inserted through other small incisions in the abdominal wall.
2.Robotic myomectomy: Here, the instruments are inserted through small incisions similar to those in a laparoscopic myomectomy. Some surgeons now perform single-port (one incision) laparoscopic and robotic myomectomies.
Sometimes, the doctors cuts the fibroid into pieces (morcellation) and then removed through a small incision in the abdominal wall. While in other time, the fibroid is removed through a bigger incision made in your abdomen so that it can be removed without being cut into pieces.
Hysteroscopic myomectomy
This is a case, where smaller fibroids bulge significantly into your uterus (submucosal fibroids). To treat this type of cases, the surgeon may suggest a hysteroscopic myomectomy, whereby the fibroids are being removed using instruments that are inserted through your vagina and cervix into your uterus.
After the procedure
During the time of discharge from the hospital, your doctor may prescribe oral pain medication, and advises how to take care of yourself, and discusses restrictions on your diet and activities. Some vaginal spotting or staining from a few days up to six weeks may be expected, depending on the type of procedure you have had.
Outcomes from myomectomy includes:
1.Relief: Post- myomectomy surgery, you may get a relief from troublesome signs and symptoms such as excessive menstrual bleeding and pelvic pain and pressure.
2.Fertility improvement: This is another important benefit you would have after myomectomy surgery. Women who undergo laparoscopic myomectomy, can have a good chance of pregnancy within a year. After myomectomy, three to six months waiting time is suggested before trying to conceive as this time allows your uterus to heal.
Fibroids that have not been completely removed could eventually grow and cause symptoms in the future. New fibroids can also develop. Women with one fibroid have a lower risk of developing new fibroids, termed as recurrence rate than women who have had multiple fibroids. It is also seen that women who become pregnant after myomectomy surgery have a lower risk of developing new fibroids than women who don’t conceive.
The department of Obstetrics & Gynaecology in Neotia Getwel Multispecialty Hospital provides comprehensive management of women’s reproductive health needs. Our trained and experienced Gynaecologists & Obstetricians complemented advanced medical infrastructure offer myomectomy surgery along with emergency high risk pregnancies, and operative open & endoscopic surgeries.
Disclaimer
Though all attempts are made to provide correct information on the subject, inadvertent & typographical errors arising out of manual intervention cannot be ruled out. It is requested to bring any such discrepancies to the notice of the blogger for correction.
