Myomectomy – Fibroids Surgery

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Laparoscopic Myomectomy Procedure for Treating Fibroids

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Laparoscopic Myomectomy Surgery for Fibroids

The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. The disadvantage is that only small fibroids can be removed by laparoscopic myomectomy and it is not recommended if there are many fibroids or if the fibroids are deeply embedded in the uterine wall.

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.

Laparoscopic Myomectomy Procedure

During this procedure a laparoscope (a thin fiber-optic device that transmits light and a video image) is inserted through a small incision, usually in the navel, to view the uterus. The image from the camera attached to the end of the laparoscope is seen on a video monitor. Two or three small (half-inch) incisions are made below the public hairline and instruments are inserted through these incisions to perform the surgery. The fibroids are detached from the uterus and removed. Following removal of the uterine fibroids, the openings in the uterus are stitched closed with the use of specially designed instruments.
Not all surgeons are trained in laparoscopic surgery; because of the small size of the incisions, removing uterine fibroids with laparoscopic myomectomy requires special training. Fibroids that are attached to the outside of the uterus by a stalk (pedunculated fibroids) are the easiest to remove laparoscopically. Many subserous fibroids (close to the outer surface) can also be removed through the laparoscope. There is a risk of leaving small fibroids untreated if there are multiple fibroids being removed by laparoscopic myomectomy.

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uterine fibroids

uterine fibroids

What are Uterine Fibroids?

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.

Myomectomy – Fibroids Surgery

Myomectomy – Fibroids Surgery

Fibroid Symptoms

Symptoms of fibroids include:

  • Heavy bleeding with periods
  • Increased pain with periods
  • Spotting throughout the month
  • Anemia or low blood counts
  • Pain in the abdomen and back
  • Difficulty with bowel movements and increased urination
  • Sub-fertility and miscarriage

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 Surgery & Myomectomy Recovery

Myomectomy as a Treatment

Growing Families

Growing Families

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

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:

1. Bleeding

2. Infection

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.

Abodominal Myomectomy Recovery

Abodominal Myomectomy Recovery

Hysteroscopic Myomectomy

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.

Recovery Time

Recovery Time

Laparoscopic 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.

Results for laparoscopic surgery performed in the best centres are comparable with conventional surgery. The advantages as far as the woman is concerned are a shorter spell in hospital, less post-operative pain and a faster return to work. However, not all fibroids are suitable for laparoscopic management and some may require conventional surgery, especially if there are three or more discreet fibroids present, or the fibroid is positioned such that access is restricted.