What Is a Myomectomy?
Myomectomy removes uterine fibroids, which can be intramural, submucosal, or subserosal. Intramural fibroids are within the muscular uterine wall, submucosal fibroids are beneath the uterine lining, and subserosal fibroids are outside the uterine wall. Myomectomy is an alternative to hysterectomy for individuals who still want to get pregnant after the treatment of fibroids. When the fibroids (intramural or submucosal) present are larger than four centimeters, and the individual desires fertility, they should be surgically removed.
What Is the Purpose of Myomectomy?
Myomectomy can help relieve:
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Heavy menstrual bleeding.
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Bleeding happens between periods.
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Iron-deficiency anemia that will lead to blood loss.
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Pelvic pain and pressure.
This procedure can also reduce serious health complications. Compression of major veins can be caused in rare cases of fibroids and lead to life-threatening blood clots.
When Myomectomy Is Indicated?
Myomectomy is a procedure to treat fibroids, which are non-cancerous tumors found in the muscle wall of the uterus. Some fibroids are small and asymptomatic, while others are large and might be symptomatic and cause discomfort. They might put pressure on the bladder and intestine or cause painful periods and heavy bleeding. Removing the fibroids can alleviate pain, pressure, and heavy flow symptoms.
What Is the Difference Between a Myomectomy and a Hysterectomy?
A myomectomy is a procedure in which only fibroids are removed, leaving the uterus in place. In the future, the menstrual period will return, and there is a chance of getting pregnant. Whereas hysterectomy is a procedure in which both the fibroids and uterus are removed, individuals who undergo hysterectomy cannot become pregnant and will not get their menstrual period.
What to Expect Before a Myomectomy Procedure?
The healthcare provider will inform if any preparation is required before the surgery, including instructions on when to stop eating and drinking or if any medications should be stopped. The healthcare provider will also give postoperative instructions on how long to stay in the hospital or surgical center and what lifestyle modifications are required during recovery.
On the day of surgery, the provider inserts the intravenous line into the vein in the arm or hand. This will provide fluids and medications during surgery. Anesthesia is also received through an intravenous line so that there is no pain during the procedure. The trained healthcare provider monitors the heart rate and other vital signs during the surgery.
What Are the Different Types of Myomectomy?
There are three main types of myomectomy.
They are:
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Open myomectomy or abdominal myomectomy.
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Minimally invasive laparoscopic or robotic myomectomy.
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Hysteroscopic myomectomy.
A decision is made on what type of myomectomy to perform based on factors such as fibroid size, number of fibroids, and location in the uterus.
Open Myomectomy
The surgeon will make an incision in the belly, and the incision might go up and down or across. This procedure is best for extremely large fibroids, as the surgeon can see all the pelvic organs. Recovery after an open myomectomy will include a few days in the hospital and rest up to six weeks at home until 100 percent of the individual feels right. The recovery from this procedure is similar to that of any other major surgery.
Minimally Invasive Laparoscopic Myomectomy
There are various minimally invasive options for myomectomy, and these surgeries generally recover faster.
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Laparoscopic or robotic myomectomy uses a lighted telescope that the surgeon will insert through the belly button. Several small incisions are made by the surgeon in the abdomen through which the surgical tools are inserted, which will help them remove the fibroids. Through the vagina or small opening in the abdomen, fibroids are removed. Sometimes, a robot-assisted myomectomy is used by the surgeon, and robots are used to control the movement of instruments.
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Single port myomectomy uses only one opening near the belly button for all the surgical instruments. This will lead to larger incision in the belly button with no other incision in the abdomen.
Hysteroscopic Myomectomy
No incision at all is required for this procedure. The surgeon removes the fibroids that are present within the uterus by fixing a camera with a specialized attachment through the vagina and into the uterus. The surgery is similar to other types.
How Is Recovery after Myomectomy?
After the surgery, there will be some pain, and the doctor will prescribe medications to treat the discomfort. There will be spotting for a few days to weeks after surgery. The longest recovery time is for open surgery. Recovery time is four to six weeks for abdominal myomectomy, two to four weeks for laparoscopic myomectomy, and two to three days for hysteroscopic myomectomy. Strenuous activities should be avoided until the incisions have fully healed. It is advisable to consult the doctor if planning a pregnancy. It is essential to wait three to six months for the uterus to fully heal, depending on which kind of surgery was done.
What Are the Risks and Complications of Myomectomy?
Complications are present in all surgeries, so the non-surgical treatment option is provided by healthcare first. Non-surgical treatment options include watchful waiting and hormonal medications that will suppress the ovaries. This will reduce the amount of vaginal bleeding, and the size of fibroids can be decreased. Myomectomy's complication rate is low, but the procedure still possesses a unique set of challenges.
The risks of myomectomy are:
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Excessive blood loss.
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Infection.
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Allergic reactions to anesthesia.
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Damage to nearby organs.
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Increased risk of requiring a C-section delivery.
These are uncommon complications, and healthcare providers will try to avoid them.
Will Myomectomy Procedure Affect the Future Pregnancy?
The likelihood of pregnancy will vary depending on the type and number of fibroids. When more than six fibroids are removed in women, they are less likely to get pregnant than those with fewer fibroids removed. There can be weakness in the uterus after this procedure. Therefore, there are chances that the uterus could tear as the pregnancy progresses or during labor. A doctor would recommend cesarean delivery to avoid complications, and it would be advised to schedule it shortly before the actual due date. Through the myomectomy incision site, a cesarean might be performed, and this will help to reduce the number of scars.
Conclusion
A myomectomy is a surgical procedure to remove fibroids from uterine muscle tissue. New fibroids may develop after the procedure. After removing fibroids, there is a chance of having children in most cases. The primary goal is to relieve the symptoms causing fibroids and reconstruct the uterus. This procedure removes only the fibroids, preserving the functional potential of the uterus.
