Myomectomy is a surgical method to remove uterine fibroids, which are non-malignant tumors. The fibroids could be single or multiple. The fibroids generally appear during the childbearing years.
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.
Fibroids could be small like seedlings or could grow up to a huge mass. The large fibroids can distort the uterus with their weight and thus during myomectomy, uterus restoration and reconstruction are also done. Myomectomy restores the uterus by removing the fibroids.
Myomectomy is a procedure of fibroid removal,
That is interfering with pregnancy.
That is eliminating fibroids by restoring the uterus.
Reduce symptoms like heavy menstrual periods and pelvic pain.
Myomectomy procedure comes with its own set of challenges like -
Excessive blood loss - Women with uterine fibroids have heavy menstrual bleeding and therefore anemic. Myomectomy could bring the patient at more risk with blood loss if any during the surgery. Doctors prepare the patient by increasing their blood count and mitigating the risk of blood loss and transfusion.
The incision on the Uterus - While removing fibroids, incisions to the uterus can develop in scars post-surgery.
Pregnancy or childbirth complications - Mandatory C-section for subsequent childbirth post-Myomectomy.
Chance of hysterectomy - Possibility of spreading cancer in the event of a cancer tumor considered as a fibroid.
The doctor might recommend the patient a certain process before initiating the surgery. This is to ensure the patient is well-prepared to face the surgery and to have minimum or no complications.
Taking Iron supplements and vitamins- To increase blood count
Correcting anemia through hormonal treatment, where the doctor prescribes a gonadotropin-releasing hormone (GnRH) agonist or birth control pills or other hormonal medication block production of estrogen and progesterone, therefore stopping menstruation for the time being, and help build hemoglobin and iron reserves.
Therapy to shrink fibroids
The GnRH also aids in shrinking the fibroid and making the surgery less invasive or laparoscopic instead of an open procedure. The GnRH therapy also decreases menstrual bleeding thereby leaving no need for surgery. This treatment is taken several months before the surgery.
Selective progesterone receptor modulators (SPRMs) may also be used to shrink fibroids and reduce bleeding.
Eating or drinking 8-10 hours before the surgery is not allowed.
The patient should inform the doctor about all the medications they are taking before the surgery.
The patient might be given local or general anesthesia before the procedure.
The surgeon may decide the procedure depending on the size, number, and location of the fibroids.
Abdominal myomectomy is the abdominal approach to remove the fibroids. A big incision horizontal or vertical is made near the bikini line. In the case of larger uteruses, a vertical incision is preferred.
Laparoscopic or Robotic Myomectomy
Laparoscopic is a minimally invasive procedure where the surgeons insert a laparoscope (a sleek light camera) through the small incisions made in the abdomen.
In robotic myomectomy, the process is much like the laparoscopic one, except the doctor operates from a console outside the abdomen. This procedure is carried out with just one incision.
This is an associated procedure to myomectomy, where the fibroid is cut into small pieces and extracted piece by piece through the small abdominal incisions.
In the case of submucosal fibroids that bulge into the uterus, a hysteroscopic myomectomy might be suggested by the doctor. The doctor will take the vaginal approach to remove the fibroids.
Patients with recurring or new fibroids can have alternate surgical treatments like -
Uterine artery embolization (UAE)
Under this process, microscopic particles are injected into the uterine arteries for limiting blood supply to the fibroid and therefore shrinking the fibroid.
Radiofrequency volumetric thermal ablation (RVTA)
This method uses ultrasound radiofrequency energy to disintegrate fibroids.
MRI-guided focused ultrasound surgery (MRgFUS)
This procedure makes use of a heat source and guided magnetic resonance imaging (MRI) to disintegrate the fibroid.
Post-surgery the patient might be discharged the same day if it is a laparoscopic or robotic myomectomy or max an overnight stay is recommended. However, in an open Myomectomy, the hospital stay can extend to a couple of days.
The patient can expect some vaginal spotting or staining up to a few days to six weeks, depending on the procedure.
In the case of pain, the doctor will prescribe medicines.
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