A myomectomy is defined as a procedure to remove fibroids (noncancerous lumps) from the uterus. Any surgery is called a major surgery if it requires an overnight or extended stay in the hospital needs anesthesia and involves removing or altering a part of the body. So, myomectomy can be considered as major surgery.
A myomectomy may be performed in several ways, depending on the size, number, and location of fibroids. Abdominal myomectomy involves an open cut on the abdomen and requires anesthesia. There is a risk of hemorrhage, anemia, wound sepsis, pelvic adhesions, and uterine rupture in subsequent pregnancies. Hysteroscopic myomectomy and a laparoscopic myomectomy are considered minimally invasive surgery.
Myomectomy is the surgical removal of the noncancerous growths that appear in the uterus, mostly during the childbearing years. These growths are called fibroids or leiomyomas. This surgery also helps in reconstructing the uterus. The procedure is usually done under general anesthesia.
- In this procedure, the abdomen is entered through a small cut near the bikini line or the pubes.
- Once inside the abdomen, the uterus is injected with a medication that narrows the blood vessels. This reduces blood loss.
- A cut is then made over the fibroid, which is then shelled out and removed.
- Once all the fibroids are shelled out, the doctor sews up the defects in the uterus in multiple layers using dissolvable stitches.
- The surgery may take about 2 hours.
- The typical recovery involves 2 nights in the hospital and 4-6 weeks resting at home.
- The procedure results in a 4-inch horizontal scar near the pubic hair or "bikini" line.
- When fibroids are small, few in number, and not deeply embedded in the uterine wall, this type of myomectomy is recommended.
- Laparoscopic myomectomy uses a slender telescope inserted through the navel to view the internal organs. Other instruments are inserted through quarter-inch incisions below the pubic hairline to accomplish cutting and maneuvering of the fibroids.
- The typical recovery involves one night in the hospital and 2-4 weeks resting at home.
- In hysteroscopic myomectomy, a special instrument is used to remove the fibroids through the vagina and cervix.
- This is an outpatient fibroid removal surgery (no hospital stay) that is only performed to treat submucosal fibroids. Submucosal fibroids grow directly out from the uterine wall and into the uterine cavity like a fetus.
- Hysteroscopic myomectomy is like a D & C (dilation & curettage). A speculum opens the vagina and instruments are guided past the cervix and into the uterus. The fluid is used to expand the uterus and any visible fibroids are scraped off the uterine wall. After the procedure, you will be under observation for a few hours. Recovery takes a few days.
Common risks and complications of myomectomy include:
- Anesthesia risks, such as headache, dizziness, vomiting
- Damage to the nearby organs
- Hole in the uterus
- Excessive bleeding
- Scarring of the tissue
- New fibroids can grow resulting in recurrent symptoms and additional procedures
- Formation of adhesions (scar tissue in the abdomen)
- Dangerous blood clots may form in the legs or lungs
- The uterus may become weaker after surgery especially in laparoscopic surgery
What is the outlook of patients after myomectomy surgery?
Myomectomy spares the uterus and all reproductive organs, which is one of the best advantages of the procedure. Myomectomy is the preferred treatment for fibroids for women who are looking to become pregnant because it leaves the uterus mostly intact. It usually takes 3 months for the uterus to heal completely. Once healed, there may be no effects on sexual activity, and patients are able to conceive. Depending on the depth of the scar in the uterus, the patient may require an elective cesarean delivery at 38 weeks to safely give birth. If myomectomy is preferred as a remedy to excessive menstrual bleeding, it is important to know that the operation is unsuccessful in around 20% of cases. However, myomectomy is usually very effective for treating fibroids and relieving the symptoms associated with them, but fibroids may grow back. This is less common in women with fewer fibroids than women who had multiple.