Laparoscopic surgery is usually performed as out-patient surgery under general anesthesia. The procedure can take one to three hours, depending on the number, size, and depth of the fibroids within the muscle wall. Following laparoscopic myomectomy many women are able to leave the hospital the same day, although a one-night stay may be necessary. Because the incisions are small, recuperation is usually associated with minimal discomfort. After laparoscopic myomectomy, women usually return to normal activity within ten to fourteen days.
Fibroids are growths in or on the uterus which are almost always benign. They vary in size and grow inside the uterine cavity (where pregnancies develop), in the uterine muscle wall itself, or on the uterine surface.
Between 30 and 40 percent of women have fibroids. Most uterine fibroids are asymptomatic and women do not even know they have them; they do not require treatment. In some women they can cause abnormal uterine bleeding, abdominal pain, pressure and sub-fertility. These cases are treated surgically with a myomectomy. There are several surgical options, including an abdominal myomectomy, hysteroscopic myomectomy, and laparoscopic myomectomy.
Symptoms of fibroids include:
Diagnosing Uterine Fibroids
Most fibroids are diagnosed with transvaginal ultrasound. If your uterine fibroid is close to or protruding into your uterine cavity, your physician may have you obtain a hysterosalpingogram or a saline sonogram to better map out the relationship of your fibroids to the uterine cavity.
Myomectomy as a Treatment
With regard to fertility treatments and pregnancy outcomes, small fibroids that do not protrude into your uterine cavity or otherwise bother you may be left alone. However, in some cases the fibroids will affect fertility, and a myomectomy will be necessary to remove them.
Abdominal myomectomy is a surgical procedure for removing fibroids through an incision on your abdomen. The incision is usually placed horizontally along the bikini line. This procedure is done in the hospital and most patients stay for 2 to 3 days before they go home.
At the time of the abdominal myomectomy, all detectable uterine fibroids are removed and the uterus is reconstructed. Oftentimes, a blue dye is placed in the cervix so that your doctor can make sure your fallopian tubes are open prior to performing your myomectomy.
Risks of Abdominal Myomectomy
Risks of abdominal myomectomy include:
3. Injury to other abdominal organs
4. Possibility of hysterectomy at the time of myomectomy (less than 1% of the time)
If after your surgery you experience fever, wound infection or abdominal pain, consult with your nurse or physician.
Abdominal Myomectomy Recovery Time
Most patients return to work within four weeks, although some may take six weeks to recover completely.
Your physician may prescribe Lupron® or Cetrotide® prior to surgery. It is used to temporarily shrink fibroids, which will make your surgery easier and help build your blood count.
Another way to remove fibroids is through a hysteroscopy. A hysteroscopic myomectomy is an outpatient procedure used to remove small protruding fibroids (submucous myomas) in the uterine cavity.
Fibroids that protrude more than 50% can be removed through the cervix using a resectoscope, a type of hysteroscope with a built in wire loop. This tiny loop can be placed in the uterus through the hysteroscope and allows your physician to remove a fibroid deep in the uterine wall by using high-frequency electrical energy to coagulate or cut the tissue.
Recovery Time of Hysteroscopic Myomectomy
This procedure is done in an operating room setting in a hospital or surgery center under local or general anesthesia. It is an outpatient procedure, so patients are discharged and go home the same day as surgery. Typically they can return to work the next day.
Notify your nurse or physician if you experience fever or abdominal pain after your hysteroscopic myomectomy.
Laparoscopy surgery is done through tiny external incisions and uses a fiber-optic camera to guide the surgeon inside the body. It is often used for gynecological procedures.
Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) or superficial fibroids that are close to the outer surface of the uterus (subserous myomas) are the easiest to remove laparoscopically. However, fibroids that are growing deep in the uterine wall (submucous myomas) are difficult to remove through laparoscopy and are often candidates for abdominal myomectomy.