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Myomectomy

A myomectomy is surgery to remove uterine fibroids while leaving the uterus intact. It is the main treatment option for patients who would still like to conceive or prefer not to have a hysterectomy.

Types
There are many different techniques for myomectomy as follows:
  1. An open myomectomy involves an incision in the abdomen similar to that for a Cesarean section, though the incision for a myomectomy is usually smaller. The doctor will remove the fibroid(s) from the uterus by separating the muscles of the uterus and removing the growth. The doctor needs to be very careful during this surgery to prevent excessive bleeding as the walls of the uterus has many blood vessels and those can be easily injured. The doctor will remove the fibroid from the front of the uterus (the side attached to the bladder) to avoid impact on the fallopian tubes and intestines and to avoid the risk of infertility in the future. Patients will be at higher risk of this problem if the fibroid is removed from the back of the uterus. The doctor will also be as careful as possible to avoid the development of adhesions.
  2. A laparoscopic myomectomy is a minimally invasive procedure where small incisions are made in the abdomen over the area where the fibroid is. A camera and surgical instruments are inserted through these incisions to visualize the uterus and act as the doctor’s eyes.
  3. A hysteroscopic hyomectomy involves the insertion of a camera and surgical instruments through the cervix into the uterus.
  4. A vaginal myomectomy is the removal of fibroids through the vagina.
  5. A robotic-assisted myomectomy involves the use of a robot to perform the surgery and is done similarly to the laparoscopic myomectomy.
Once you and your doctor have decided that myomectomy is the appropriate choice for you, the surgery will be scheduled. Before the day of the surgery you will receive instructions regarding preparing for surgery as follows:
  1. Arrive at the hospital at least four hours before the procedure.
  2. Avoid food and water for at least eight hours before the procedure or as recommended by the doctor to prevent aspiration while under general anesthesia. Be sure to get enough sleep the night before the procedure.
  3. Do not wear any make-up or paint your nails before coming to the hospital. This allows the medical staff to better assess your circulation visually during and after the surgery.
  4. Do not bring any jewelry or valuables to the hospital to prevent any loss. Removable dentures and contact lenses have to be removed before entering the operating room.
  5. The doctor will assess your readiness for the surgery by ordering blood tests as well as chest x-ray and electrocardiogram (EKG) before the day of the procedure.
  6. The doctor will give you recommendations regarding medication that you are currently taking. Some may need to be stopped for a period before surgery, such as blood-thinning medication, aspirin, and certain supplements that can cause excessive bleeding. The doctor will determine which medication to discontinue and which you can still take up until time of surgery, usually with a small sip of water.
  7. Avoid smoking for at least one week before the procedure.
  8. A friend or family member must be at the hospital with you while you are in surgery and should stay with you while you are admitted at the hospital.
  1. After the procedure you will be moved into a recovery room where you will be closely monitored as you recover from anesthesia.
  2. You will be moved into a room where you will stay until you are recovered enough to go home. Normally you will stay in the hospital for two days after a laparoscopic or vaginal myomectomy and four to five days for an open procedure. If you experience any side effects from the anesthesia, such as headache, nausea, or vomiting please let the nurse know right away so you can be prescribed medication to manage these symptoms.
  3. A urinary catheter will have been placed during surgery and will be removed when you are able to get up and use the toilet yourself.
  4. You will be given instructions on moving your bowels and avoiding constipation, which can be a side effect of abdominal surgery and pain medication. You will be prescribed medication for this as needed.
  5. Move as much as you comfortably can after the procedure to prevent deep vein thrombosis. Take at least 10 deep breaths every hour to encourage lung function and prevent infection.
  6. If you smoke, you should quit. Smoking increases the risk of infection and can cause coughing, which can impact the incision in the abdomen.
  7. It is normal to feel fatigued after surgery. Do as much as you comfortably can. Full recovery takes approximately six weeks and many patients say it takes them up to six months to feel completely back to normal. Do not lift any heavy objects in the first six weeks after the procedure to allow all stitches to heal. Avoid sexual intercourse for six weeks.
  1. Avoid driving for at least one month after the surgery.
  2. Avoid traveling by plane for at least two weeks after the surgery, but please talk to your doctor before making any travel arrangements.
Like with any surgery, a myomectomy may cause infection, excessive bleeding, and impact to nearby organs. Some patients may experience reopening of the wound in the uterus, but this is rare and may occur in less than one percent of patients. In extremely rare cases, excessive bleeding may require a hysterectomy. Please discuss all concerns and questions with your doctor before the procedure.
This procedure has a 90-95% success rate, depending on many factors, including the patient’s health and medical condition.
 
What if the procedure is not performed?
Symptoms will persist, including prolonged abnormal bleeding and pain.
 
Alternatives
  1. A minimally invasive procedure using a laparoscope through the abdomen may be an option for fibroids that develop outside the uterus, but this technique has limitations and will only work with very small growths that can be clearly visualized. There is also a risk of adhesions forming within the pelvis.
  2. Hysteroscopic myomectomy, vaginal myomectomy, and laparoscopic myomectomy can be used to remove small fibroids. These are outpatient procedures and recovery is much quicker than open surgery. Most patients feel back to normal within days. However, if the fibroid is embedded into the uterine wall, this procedure is not an option.

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