Types of Myomectomy

Types of Myomectomy

Performed during hysteroscopy (a hysteroscope is a viewing device inserted through the vagina and cervix) with the aid of a resectoscope (a device to cut and section the fibroid) to treat submucosal fibroids (inside the uterine cavity) Other types of myomectomy may be performed during this procedure if intramural or subserosal fibroids are present also.

Laproscopic Myomectomy

Laproscopic procedure which removes the fibroids and repairs the defect left where the fibroid was located. Proper repair of the defect is of extreme importance in the prevention of complications. A small incision is made, usually in the navel, and a laproscope is inserted through which the myomectomy is performed. This type of myomectomy offers the fastest recovery time.

Laproscopic Myomectomy with Colpotomy

A laproscopic procedure which involves an incision in the vagina to remove large pieces of fibroids. This procedure does not close the defect left by the fibroid and must be performed in conjunction with another procedure.

Laproscopic Minilap Myomectomy

Laproscopic Assisted Myomectomy (LAM) is a laproscopic procedure which also includes a small traditional abdominal incision to remove the fibroids. This type of procedure can be used for any size of fibroid. Because the incision is only 4-5 cm recovery is quicker than from a conventional myomectomy.

Conventional Myomectomy

This is still the most commonly performed type of myomectomy because laproscopic myomectomies are difficult to perform and many physicians are untrained in laproscopic procedures. A traditional myomectomy requires a 5-7 inch abdominal incision, 3-5 days hospitalization, and 6-8 weeks for recovery.

Are there any new procedures for treating fibroid tumors?

Another recently introduced procedure is myolysis. Myolysis involves cutting the blood supply as above but also uses an electric current such as a laser to 'drill' into the center of the fibroid causing destruction of the blood vessels and the inner portion of the fibroid tumor; several 'drills' are required for each fibroid to be destroyed.

Questions to Ask Your Physician

• Why are you recommending myomectomy now? - Are they causing pain, abnormal bleeding, or other severe symptoms?)
  
  
• What are the risks if I decide against myomectomy? - excessive bleeding, anemia, bowel or bladder obstruction caused by large fibroids, pain, ect.)
  
  
• How often do you perform myomectomies? - Choose a physician who regularly performs myomectomies.
  
  
• Can you perform a myomectomy without regard to the size or location of fibroids? - All fibroids can be safely removed with myomectomy, regardless of size or location, if your physician is adequately experienced in myomectomy.
  
  
• What type of myomectomy are you advising for me? Why? - Different types of fibroid require different types of procedures.
  
  
• Will I require blood transfusions? - Any surgery presents the risk of loss of blood, myomectomy presents increased risks.

Remember, your physician should explain all possible options before you make your decision. If your physician does not offer myomectomy for fibroids and insists on hysterectomy, it is most likely because he is not experienced enough to safely perform myomectomy and you should ask him for a referral to a physician who is experienced in performing myomectomy. A good physician will gladly give you such a referral and a second opinion is always a wise choice before any major surgery.

_Source:

_{Uterine Fibroids. ACOG Education Pamphlet AP074. http://www.acog.org/publications/patient_education/bp074.cfm. Accessed 08/24/09.}

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