Myomectomy is a surgical procedure for removing uterine fibroids. The fibroids are non-cancerous tumor growth within the cell or the uterus or outside the uterus, that is formed during the fertile years of a woman.
Myomectomy is carried out to remove the symptomatic fibroids and reclaim the uterus. Myomectomy procedure removes only the fibroids, unlike hysterectomy that removes the uterus too. Under myomectomy, the surgeon's goal is to repair and restore the uterus.
Myomectomy also helps in reducing the most obvious symptoms of fibroids- menstrual bleeding and pelvic pressure.
Myomectomy is recommended in patients who are-
Planning a pregnancy.
Fibroids that might be interfering with the patient's fertility.
The uterus is disturbed and needs to be restored.
Myomectomy might not be a very feasible process for all women. The doctor will decide the procedure depending on the patient's condition.
Myomectomy has low complications, yet some challenges cannot be denied like-
Excessive blood loss-
Some women have low blood count due to heavy menstrual bleeding. For conducting the myomectomy process, the doctor will first recommend increasing the patient’s blood count.
Scar tissue -
Scar tissues are incisions in the uterus to remove fibroids, which can lead to adhesions ( bands of scar tissue) during the surgery.
Pregnancy or childbirth complications -
Myomectomy between two subsequent pregnancies can lead to the 2nd delivery as a cesarean (c-section). This is to avoid the rupture of the uterus wall during delivery and it is a rare kind of complication.
Chances of Hysterectomy
The surgeon might have to decide on a hysterectomy in case the bleeding is uncontrollable and abnormalities are encountered.
Rare chance of spreading a cancerous tumor.
Rarely and mistakenly a cancer tumor that is considered as a fibroid might lead to the spread of cancer.
The patient is recommended to be on an empty stomach for at least 8-10 hours.
If the patient is on prior medication, the same should be communicated to the doctor.
Anesthesia will be again given on a case to case basis. It could be general or local anesthesia.
Laparoscopic or robotic myomectomy is an outpatient procedure and in some cases, the patient might be kept under observation overnight. However, hysteroscopic myomectomy does not need an overnight hospital stay.
Laparoscopic or Robotic Myomectomy
Laparoscopic or robotic myomectomy are minimally invasive procedures and remove fibroids through the abdomen.
The procedure takes three to four small incisions. Carbon dioxide gas is passed through the incision to inflate the abdomen for better visibility and ease of working on the organs.
A laparoscope (a slender tube fitted with a light camera) is introduced through an incision and the other incisions, different surgical incisions are inserted.
The procedure is image-driven and the surgeon operates under the guidance of the video of the abdomen reproduced on the screen.
Once the procedure is over, the surgical instruments are removed as well as the carbon dioxide gas.
Laparoscopy is ideal as there is less blood loss, faster recovery, and lesser stay in the hospital. There are fewer complications compared to open surgery.
The robotic myomectomy works on a similar procedure as laparoscopic. Under robotic myomectomy, the surgical instruments are controlled through a separate console.
The procedure is the least invasive with some surgeons operating through a single port (one incision) itself.
In both the procedure, the fibroids are broken down into pieces (called morcellation) and then removed piece by piece through the incisions.
Hysterectomy is an associated procedure that is not common to all myomectomies. In case there are complications during the myomectomies, the surgeon might opt for a hysterectomy (removal of the uterus).
The patient can be sent back the same day or asked to stay under observation overnight.
The patient may have vaginal spotting or staining from several days to a couple of weeks.
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