Myomectomy is the surgical removal of fibroids. A number of medical and surgical treatment modalities are available for the treatment of uterine fibroids, but myomectomy surgery is mainly indicated for women who want to get pregnant in the future. Occurrence of uterine fibroids makes it difficult for some women to conceive and bear a child. Myomectomy surgery aims at surgical removal of the fibroids followed by reshaping and restructuring of the uterus. Myomectomy surgery also improves the chances of your pregnancy but does not guarantee it.
What are fibroids ?
Fibroids are basically benign growths (not cancerous) affecting the uterus. They are growths arising from the muscular lining of your uterus. Fibroids can vary in their point of origin that is they can be located either in the uterus or outside it, attached to its wall. The number of fibroids can also be exceedingly variable, ranging from single to few to multiple.
How do you know if you have fibroids ?
It is mostly seen in women who are in the 3 rd to 4th decades of their life. A lot of the times, fibroids have no symptoms and are detected only on routine examinations. If symptomatic, the signs may be if you have a change in your menstrual periods, either in being longer or more frequent, as well as in being more painful (dysmenorrhoea). You may also get anaemia from excessive bleeding or a pain or swelling in the abdominal area. Miscarriages and infertility can result in larger fibroids.
How are fibroids diagnosed ?
Imaging examinations of the uterus include ultrasonography (the first line of investigation in uterine fibroids), hysteroscopy (seeing the uterus by a telescope with a light and camera at the end, inserted via the vagina), hystersalpingography (a x-ray examination of the uterus and fallopian tubes, using special fluoroscopy and a contrast material) and laparascopy (a low-risk, minimally invasive procedure requiring minute incisions to insert a laparoscope to see the abdominal organs).
What are the indications of myomectomy surgery ?
Myomectomy is a gynecological surgical procedure indicated in women who are affected with uterine fibroids. Presence of uterine fibroids leads to difficulty in pregnancy and increases the chances of pregnancy related complications. Uterine fibroids are of mainly three types: the intramural fibroid, the submucosal fibroid and the subserosal fibroid. The submucosal fibroid will grow as a muscular bulge into the uterine cavity; intramural fibroids grow surrounded and contained within the wall of the uterus; and the third type, the subserosal fibroid grows on the outside wall of the uterus. Presence of a submucosal fibroid or fibroids in the uterus is a prime indication for a myomectomy surgery. Myomectomy surgery is also an indication for women who are anemic or are affected with infertility and frequent miscarriages.
What are the contraindications of myomectomy surgery ?
Myomectomy surgery is not indicated when the consulting specialist is suspecting a uterine or a cervical cancer as it may lead to further complications. Myomectomy surgery is also not indicated when you are pregnant.
How do you decide if myomectomy surgery is indicated for you ?
Uterine fibroids are a fairly common problem which can be asymptomatic or associated with pain in the abdomen, infertility, hormonal imbalance, difficulty and complications during pregnancy. It is when fibroids become painful, or if they hinder fertility and conception, or cause irregular and drawn out periods, they need treatment.
The possible surgical modalities of treatment of uterine fibroids are basically of two types, hysterectomy and myomectomy. Whereas hysterectomy is removal of the uterus, myomectomy is removal of only the fibroid (that is removal of the muscular layer of the uterus), without removal of the uterus. In that sense, myomectomy is a uterus-preserving technique. It can allow for subsequent pregnancies as well as not cause menopause. It is essential to consult a specialist, a gynaecologist who would conduct a complete physical examination along with other adjuncts like ultrasonography, scans like CT and MRI scan to identify the exact type and the location of the fibroid. After complete evaluation and analysis of your symptoms, the specialist would advise if you are a suitable candidate for a myomectomy surgery. It is essential to ask the operating surgeon in detail about the risks, benefits and outcome of the procedure before getting the surgery done.
What are the types of myomectomy surgery ?
Depending upon the type of fibroid, the location of the fibroid and the number of fibroids the choice of type of myomectomy surgery is done.
- Abdominal myomectomy surgery or Conventional myomectomy surgery
- Laparoscopic myomectomy surgery or Robotic myomectomy surgery
- Hystersocopic myomectomy surgery
The choice of the type of myomectomy surgery is done only after complete evaluation of the patient’s symptoms and overall health and analysis of risks and benefits of the type of myomectomy surgery.
Does myomectomy surgery require administration of anesthesia ?
Yes, the procedure requires administration of general anesthesia as it is a major surgical procedure.
What happens during a myomectomy surgery ?
Myomectomy is major surgical procedure and during the abdominal myomectomy surgery either a horizontal bikini line incision is given which roughly about 2-3 cm in length above the pubic bone or a vertical incision which starts just below the navel till the pubic bone. The surgical access is better in a vertical incision but scar is thinner in case of a horizontal line incision approach, hence the latter is preferred.
In a laparoscopic or a robotic myomectomy surgery several small incisions are given on the abdomen which provide access to removal of fibroids with the use of laparoscope which cuts the fibroids into smaller pieces which are then removed from the abdominal wall.
Hysteroscopic myomectomy surgery is indicated in case of submucosal uterine fibroids which project into the uterine cavity. This procedure is performed with a special instrument called as the resectoscope which is inserted into the uterus via the vagina and later is used to shave the pieces of fibroids and reshape the uterus to help in future pregnancy.
What happens after myomectomy surgery ?
A conventional abdominal Myomectomy takes about four to six weeks for complete healing where as the recovery is faster with laparoscopic and a hysteroscopic Myomectomy procedure. The length of the stay in the hospital usually ranges from 1-2 days after the surgery. A lot of post-operative care has to be taken for two weeks after surgery. Avoid heavy physical activities for atleast six weeks. Smoking is best stopped as it interferes with healing.
The doctor and the nurse might ask you to abstain from doing any sports, lifting heavy objects, exercising, engaging in sexual activity and avoid using tampons as these may lead to further complications. It is essential to visit the surgeon for routine follow-ups to assess the condition of the uterus and recurrence of fibroids after the surgical procedure.
Myomectomy surgery as mentioned earlier is indicated in women who wish to get pregnant but are not able to conceive because of uterine fibroids. Though myomectomy surgery does not guarantee the chances of pregnancy but it surely increases it. It is advised to consult your specialist if you encounter any of the complications after the procedure. The literature suggests that myomectomy surgery is a suitable procedure for providing symptomatic relief and improving the chances of getting pregnant, hence if you are affected with the above mentioned symptoms it is advised to consult a specialist to appropriately examine you and suggest if myomectomy surgery is the choice of treatment for you.
It is essential to consult your treating specialist for appropriate planning of pregnancy. Since uterine fibroids have a tendency to recur it is generally advised to plan a pregnancy shortly after the myomectomy surgery.
What are the risks of myomectomy surgery ?
Since myomectomy is a major surgical procedure, surgical complications like pain, bleeding and infection can occur at the site of the surgery. Anaesthesia related complications like dizziness, nausea, vomiting and abdominal discomfort might also be observed in some patients. Occasionally, myomectomy might be associated with pelvic pain and vaginal bleeding post operatively.
How to find gynaecologists for myomectomy surgery ?
Now you can find gynaecologists from different hospitals and destinations for myomectomy surgery. You can avail opinions and information from multiple gynaecologists, get approximate cost for myomectomy surgery from various hospitals, compare things and then choose a gynaecologist for myomectomy surgery. You can do all these things on a single platform, Hinfoways. Find a gynecologist for myomectomy surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
