Myomectomy Surgery

Myomectomy is a surgical procedure to remove uterine fibroids.

What is a Myomectomy?

Myomectomy is the treatment of choice in women with fibroids who are planning to have children. This is indicated for large fibroids distorting the uterine cavity and smaller submucosal (intra-cavitary) fibroids.

Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.

Types of Myomectomy

Depending on the size, location and number of fibroids, Dr Turner may choose one of three surgical approaches to remove the fibroids:

• Hysteroscopic Myomectomy: This is performed to remove a fibroid growing into the uterine cavity. Hysteroscopic myomectomy is performed under general anaesthesia or spinal anaesthesia. Dr Turner uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Dr Turner can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Dr Turner may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that has not gone deep within the wall of the uterus can be removed using this technique.
• Laparoscopic Myomectomy: A laparoscopic myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached to a camera, is used. A small incision is usually made below the navel, and a laparoscope is inserted through this incision. Carbon dioxide gas is injected into the abdominal cavity to create more space to work. Dr Turner identifies and removes the fibroids. During the procedure, tissue samples can also be taken for biopsy. This procedure is the preferred option to remove one or two fibroids up to 10cm across that grow in the wall or outside the uterus.

An incision is made in the uterus over the fibroid. The fibroid in the uterus is removed and the uterus sutured laparoscopically.

• Laparotomy: A laparotomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many or have grown deep into the uterine wall, Dr Turner may opt for laparotomy.

Patient Suitability for Myomectomy

A myomectomy is a treatment option if

• you have heavy menstrual bleeding, especially if causing anaemia and pain not relieved with medications.
• the fibroid is causing bladder or rectal pressure and irritability
• the fibroids have changed the uterus to cause infertility or repeated miscarriages.
• the fibroid is so large as to cause abdominal swelling
• The fibroid is progressively growing larger.

Recovery from Myomectomy

After myomectomy surgery, your pelvic pain and bleeding from fibroids are reduced, and your chances of having a baby are improved. However, new fibroids may grow after the surgery. Complications with Myomectomy

The possible complications of myomectomy include

• Infection,
• bleeding/need for blood transfusion
• Adhesion formation causes bowel obstruction or infertility,
• rupture of the uterine scars in late pregnancy or during labour - thus, Caesarean delivery is often recommended

Rarely an emergency hysterectomy is required. Rarely, a myomectomy causes uterine scarring that can lead to infertility.

Fibroids and Pregnancy

Fibroids can grow back. Women planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, Dr Turner will advise you to wait for 3 - 6 months until the uterus heals.

The incisions made in the uterus wall to remove fibroids may cause placental problems. Caesarean delivery is often recommended, especially if the uterine cavity is entered. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.