Myomectomy

Overview

A myomectomy is a surgical procedure designed to remove uterine fibroids, also known as leiomyomas. These fibroids are noncancerous growths made up of connective tissue and muscle cells, which can appear inside or outside the uterus. The procedure aims to excise the fibroids while preserving the surrounding uterine tissue, thereby allowing the possibility of future pregnancies.

Unlike a hysterectomy, which involves the removal of the entire uterus along with the fibroids, a myomectomy focuses solely on eliminating the fibroids themselves. This approach helps to maintain the integrity of the uterus, which can be important for women who wish to retain their fertility.

Many women who undergo a myomectomy experience significant relief from fibroid-related symptoms, such as heavy menstrual bleeding and pelvic pressure. By removing the problematic fibroids, the procedure can greatly improve quality of life and reduce discomfort.

Types

There are several main types of myomectomy:

• Open myomectomy or abdominal myomectomy
• Laparoscopic or robotic myomectomy
• Single port myomectomy
• Hysteroscopic myomectomy:

Reasons for undergoing the procedure

A myomectomy might be recommended for uterine fibroids if:

• You plan to have children.
• There is concern that fibroids are affecting your fertility.
• You wish to keep your uterus.
• You are experiencing symptoms like pelvic pain, irregular bleeding, heavy menstrual bleeding, or difficulty emptying your bladder.

Choosing a myomectomy can help preserve your fertility and allow for future pregnancy.

Risk

The following risk of myomectomy may include:

• A higher chance of requiring a C-section delivery in the future.
• Allergic reactions to anesthesia.
• Blood clots.
• Excess bleeding.
• Infection.
• Injury to surrounding organs.
• Scar tissue.

Although these risks are uncommon, your healthcare team will implement every precaution to minimize risks and ensure a safe procedure.

Before the procedure

Your healthcare provider will give you specific instructions on how to prepare for your surgery, including when to stop eating and drinking, and whether you need to pause any medications. They will also offer post-operative guidance, such as how long you can expect to stay in the hospital and any lifestyle changes you may need during your recovery. Make sure to ask your provider any questions you have beforehand to fully understand what to expect.

On the day of your surgery, the following steps will typically occur:

• An IV (intravenous line) will be inserted into a vein in your arm or hand to administer fluids and medications, including anesthesia, to keep you comfortable and pain-free during the procedure.
• Monitors will be attached to track your heart rate and other vital signs throughout the surgery.
• A catheter may be used to keep your bladder empty during the procedure.

The duration of the surgery can vary depending on the type of procedure, the location, and the number of fibroids being removed, usually lasting between two and three hours. For more precise information, discuss the expected duration with your healthcare provider on the day of the surgery.

You may need someone to accompany you on the day of the surgery. Ensure you have a person ready to help with transportation and support throughout the process.

During the procedure

Your surgeon may suggest one of the following procedures for your myomectomy, depending on the number, location, and size of your fibroids.

• Open myomectomy or abdominal myomectomy: In an open myomectomy, also known as abdominal myomectomy or laparotomy, the surgeon makes a cut (incision) in the abdomen, which can be either vertical or horizontal. This approach is often preferred for extremely large fibroids as it allows the surgeon to view all the pelvic organs. Typically, a low, horizontal (“bikini line”) incision is used, when possible, but a vertical incision may be necessary for larger uteruses. Recovery from an open myomectomy is comparable to that of other major surgeries.
• Laparoscopic or robotic myomectomy: In laparoscopic or robotic myomectomy, which are minimally invasive procedures, the surgeon starts by inserting a small, lighted telescope through the belly button, followed by making several additional small incisions in the abdomen for surgical tools to remove fibroids. These fibroids are then extracted either through the vagina or through the small abdominal openings. Laparoscopic myomectomy generally results in less blood loss, shorter hospital stays, quicker recovery, and fewer complications and adhesion formation compared to open myomectomy (laparotomy). Although robotic myomectomy might be more expensive and time-consuming, its outcomes are similar to those of traditional laparoscopic procedures.
• Single port myomectomy: This surgery involves a single incision near the belly button for all surgical instruments. Although this requires a slightly larger incision at the belly button, it eliminates the need for additional incisions on the abdomen.
• Hysteroscopic myomectomy: Hysteroscopic myomectomy is a procedure that requires no external incisions. Instead, the surgeon inserts a camera with a specialized attachment through the vagina to access and remove fibroids directly from the uterus. This method is particularly effective for smaller fibroids that protrude significantly into the uterine cavity (submucosal fibroids). By using instruments inserted through the vagina and cervix, the surgeon can quickly and effectively remove the fibroids without the need for more invasive techniques.

The choice of myomectomy type depends on several factors, including the size and number of fibroids and their location within the uterus.

After the procedure

When you’re discharged from the hospital, your healthcare provider will prescribe oral pain medication, offer self-care instructions, and discuss any dietary and activity restrictions. Depending on the procedure, you might experience vaginal spotting or staining, which can persist for a few days to up to six weeks.

Outcome

The benefits from myomectomy may include the following:

• Symptom relief: Following myomectomy surgery, most women notice a significant decrease in troublesome symptoms like heavy menstrual bleeding, pelvic pain, and pressure.
• Improved Fertility: Women who have laparoscopic myomectomy, with or without robotic assistance, often achieve positive pregnancy outcomes within a year of the procedure. It is advisable to wait three to six months after surgery before trying to conceive to give your uterus sufficient time to heal.

However, fibroids that were not detected or fully removed during surgery may eventually regrow and cause symptoms. Additionally, new fibroids can develop and may or may not require treatment. Women who had only one fibroid typically have a lower risk of developing new fibroids, or recurrence, compared to those who had multiple fibroids. Furthermore, women who become pregnant after surgery generally have a lower risk of new fibroids than those who do not.

Regardless of the type of myomectomy you undergo, you should plan for at least a few days of rest following the procedure. The amount of recovery time needed will vary depending on the specific surgery performed. If possible, arrange for assistance at home for the first one to three days after the surgery. Consult with your provider about when it will be appropriate to resume your normal activities and adhere to their guidance.

If you have a myomectomy to remove fibroids, contact your healthcare provider immediately if you notice any of the following:

• Excessive bleeding
• Fever, chills, or other flu-like symptoms
• Pain that cannot be controlled with medication
• Chest pain or difficulty breathing
• Redness, swelling, or cramping in your legs