Myomectomy is a type of surgery used to remove uterine fibroids. Your doctor might recommend this surgery if your fibroids are causing symptoms such as:

  • pelvic pain
  • heavy periods
  • irregular bleeding
  • frequent urination.

A myomectomy can be done one of three ways:

Abdominal myomectomy lets your surgeon removes your fibroids through an open surgical cut in your lower belly.
Laparoscopic myomectomy allows your surgeon to remove your fibroids through several small incisions. This may be done robotically. It’s less invasive and recovery is faster than with abdominal myomectomy.
Hysteroscopic myomectomy requires your surgeon to use a special scope to remove your fibroids through your vagina and cervix.

Myomectomy is an option for women with fibroids who wish to get pregnant in the future, or who want to keep their uterus for another reason.

Unlike a hysterectomy, which takes out your entire uterus, myomectomy removes your fibroids but leaves your uterus in place. This allows you to try for children in the future.

The type of myomectomy your doctor recommends depends on the size and location of your fibroids:

Abdominal myomectomy may be best for you if you have many or very large fibroids growing in your uterine wall.
Laparoscopic myomectomy may be better if you have smaller and fewer fibroids.
Hysteroscopic myomectomy may be better if you have smaller fibroids inside your uterus.

Preparation:

Before you have surgery, your doctor may prescribe medication to reduce the size of your fibroids and make them easier to remove.

Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are drugs that block production of estrogen and progesterone. They will put you into temporary menopause. Once you stop taking these medications, your menstrual period will return and pregnancy should be possible.

Investigations before surgery :

  • blood tests
  • electrocardiogram
  • MRI scan
  • pelvic ultrasound

If you smoke, stop six to eight weeks before your surgery. Smoking can slow your healing process as well as increase your risk of cardiovascular events during your surgery

Procedure:

The procedure will differ depending on what type of myomectomy you’re having.

Abdominal myomectomy:
During this procedure, you’ll be placed under general anesthesia.

Your surgeon will first make an incision through your lower abdomen into your uterus. This can be done in a couple of ways:

A horizontal incision 3 to 4 inches long, just over your pubic bone. This type of incision causes less pain and leaves a smaller scar but may not be big enough to remove large fibroids.
A vertical incision from just below your belly button to just above your pubic bone. This incision type is rarely used today but it may work better for larger fibroids and cuts down on bleeding.
Once the incision is made, your surgeon will remove your fibroids from your uterine wall. Then they’ll stitch your uterine muscle layers back together.

Laparoscopic myomectomy:
While you’re under general anesthesia, your surgeon will make four small incisions. These will each be about ½-inch long in your lower abdomen. Your belly will be filled with carbon dioxide gas to help the surgeon see inside your abdomen.The surgeon will then place a laparoscope into one of the incisions. A laparoscope is a thin, lighted tube with a camera on one end. Small instruments will be placed into the other incisions.

If the surgery is being done robotically, your surgeon will control the instruments remotely using a robotic arm.

Your surgeon may cut your fibroids into small pieces to remove them. If they are too large, your surgeon may change to an abdominal myomectomy and make a larger incision in your abdomen.Afterward, your surgeon will remove the instruments, release the gas, and close your incisions. Most women who have this procedure stay in the hospital for one night.

Hysteroscopic myomectomy:
You will get a local anesthetic or be placed under general anesthesia during this procedure.

The surgeon will insert a thin, lighted scope through your vagina and cervix into your uterus. They’ll place a liquid in your uterus to widen it to allow them to see your fibroids more clearly.

Your surgeon will use a wire loop to shave off pieces of your fibroid. Then, the liquid will wash out the removed pieces of fibroid.

You should be able to go home the same day as your surgery.

Recovery:

Recovery times for each procedure are:

  • abdominal myomectomy: four to six weeks
  • laparoscopic myomectomy: two to four weeks
  • hysteroscopic myomectomy: two to three days

Don’t lift anything heavy or exercise strenuously until your incisions have fully healed. Your doctor will let you know when you can return to these activities.

Complications:

  • infection
  • excessive bleeding
  • damage to nearby organs
  • a hole (perforation) in your uterus
  • scar tissue that could block your fallopian tube or lead to fertility problems
  • new fibroids that require another removal procedure

Immediate action need to be taken,if the below symptoms persists

  • heavy bleeding
  • fever
  • severe pain
  • trouble breathing

Effect of Myomectomy on Pregnancy :

Your likelihood of pregnancy depends on the type and number of fibroids you have. Women who have more than six fibroids removed are less likely to get pregnant than those who have fewer fibroids removed.Because this procedure can weaken your uterus, there is a chance that your uterus could tear as your pregnancy progresses or during labor. Your doctor will likely recommend that you have a cesarean delivery to prevent this complication. They may recommend scheduling this shortly before your actual due date.Your cesarean might be able to be performed through your myomectomy incision site. This can reduce the number of scars you have.

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