Purpose of Myomectomy

A myomectomy is a procedure that can remove fibroids and preserve the uterus. Sometimes this type of surgery can be a safe and effective alternative to a hysterectomy, which is the surgical removal of the uterus.

Preparation

Before having a myomectomy, you may need preoperative preparation, which often includes treatment with Lupron Depot (leuprolide acetate) for about three months preceding the procedure. Lupron inhibits estrogen production, causing the fibroids to shrink in size. During this time, menstruation usually ceases.

There are some pros and cons to pretreatment with Lupron:

• It is expensive.
• It causes menopausal symptoms such as hot flashes and night sweats.
• It may shrink some very small fibroids to a point where they will not be visible during surgery, and these unseen fibroids can grow again and possibly require additional surgery.

A successful myomectomy should provide complete relief from all of the symptoms associated with fibroid tumors. However, fibroids often grow back, necessitating the need for a hysterectomy later on.

You can safely have a repeat myomectomy, but each time, there is an increased risk of pelvic adhesions, which is a type of post-surgical scar tissue that can cause symptoms.

Associated Risks

Complications are rare when a myomectomy is performed properly, but it is important to be aware of the possible risks if you are considering having this procedure.

Possible complications include:

• Blood loss
• Ileus (slowing of intestinal movements)
• Bowel obstruction
• Anemia
• Pain
• Infertility

It is possible that the surgery would need to be converted to a hysterectomy during the procedure. Some complications may require surgical treatment.

Pregnancy is still possible after a myomectomy, and some women who become pregnant following a myomectomy might need to have a cesarean section due to a potential weakening in the uterine wall.

General Procedure

Before the surgery, anesthesia is started and a catheter is inserted into the bladder to keep it empty during the procedure.

Another catheter is inserted into the uterus and a dye is injected to stain the uterine cavity; this staining helps with visualization to determine the location of the fibroids.

During your procedure:

• A drug is injected into the first fibroid slated for removal, temporarily stopping the blood supply to the fibroid so it can be removed with less risk of excessive bleeding and transfusion.
• The space where the fibroid was removed is closed carefully. Each layer of tissue is sutured individually to prevent clots and other complications.
• As each fibroid is removed, this process is repeated.

The dye also runs into the fallopian tubes and can help determine whether they are blocked or open. Repairs to the fallopian tubes can also be made during this procedure.

Types of Myomectomy

There are several different myomectomy techniques. This surgery can access the fibroids vaginally or abdominally, using a variety of different methods. The type of myomectomy that you would have depends on many factors, such as the size and location of your fibroid tumors.

Conventional Myomectomy

This is the most commonly performed type of myomectomy. A traditional myomectomy requires a 5-7 inch abdominal incision, less than 24 hours of hospitalization, and six to eight weeks for recovery.

Laparoscopic Myomectomy

During this procedure, a small incision is made, usually in the navel, and surgery is performed using a small laparoscope that is inserted into the uterus through the abdominal wall. This type of myomectomy offers the fastest recovery time.

Laparoscopic Minilap Myomectomy

This is a procedure that includes a small traditional abdominal incision to remove the fibroids. This type of procedure can be used for any size fibroid. Because the incision is only 4-5 cm, recovery is quicker than from a conventional myomectomy.

Laparoscopic Myomectomy With Colpotomy

This is a procedure that involves an incision in the vagina to remove large pieces of fibroids. This procedure does not close the defect left by the fibroid.

Trans-Cervical Myomectomy

This is performed during a hysteroscopy with the aid of a resectoscope to treat submucosal fibroids. Other types of myomectomy may be performed during this procedure if intramural or subserosal fibroids are present.

What to Ask Your Healthcare Provider

Your healthcare provider should explain all possible fibroid treatment options before you make your decision.

Some questions you might want to ask:

• Why is your doctor recommending a myomectomy now?
• What are the risks of deciding against myomectomy?
• How often does your doctor perform myomectomies?
• What type of myomectomy is recommended for you? Why?
• Will you require blood transfusions?
• Will you need to take preoperative treatment to shrink your fibroid?