Myomectomy is a surgical operation used to remove uterine fibroids, also known as leiomyomas). These noncancerous growths commonly occur in the uterus. Uterine fibroids are more common during the childbearing years, but they can appear at any age.
During a myomectomy, the surgeon's objective is to remove symptom-causing fibroids and rebuild the uterus. In contrast to a hysterectomy, which removes your whole uterus, a myomectomy removes only the fibroids while leaving your uterus intact.
Women who get a myomectomy report a reduction in fibroid symptoms, such as heavy menstrual flow and pelvic discomfort.
Your surgeon may choose one of three surgical techniques for myomectomy depending on the size, number, and location of your fibroids.
Myomectomy of the abdomen
Your surgeon will create an open abdominal incision to reach your uterus and remove fibroids during an abdominal myomectomy (laparotomy). If at all feasible, your surgeon will want to create a low, horizontal ("bikini line") incision. Larger uteruses necessitate vertical incisions.
Your surgeon accesses and removes fibroids using many tiny abdominal incisions during laparoscopic myomectomy surgery, which is a minimally invasive procedure.
Women who have a laparoscopy had less blood loss, shorter hospital stays and recuperation, and reduced incidence of problems and adhesion development following surgery as compared to women who have a laparotomy.
The fibroid may be broken into pieces and removed by a tiny incision in the abdominal wall. Other times, the fibroid is removed through a larger incision in your belly so that it is not cut into pieces. In rare cases, the fibroid may be removed through a vaginal incision (colpotomy).
Myomectomy via hysteroscopy surgery
A hysteroscopic myomectomy may be recommended by your surgeon to treat tiny fibroids that protrude considerably into your uterus (submucosal fibroids). The fibroids are accessed and removed by the surgeon using devices put via your vagina and cervix into your uterus.
This is usually followed by a hysteroscopic myomectomy:
A tiny, illuminated tool is inserted through your vagina and cervix and into your uterus by your surgeon. He or she will most likely employ a wire loop resectoscope to electrically cut (resect) tissue or a hysteroscopic morcellator to manually cut the fibroid with a blade.
To enlarge your uterine cavity and allow inspection of the uterine walls, a transparent liquid, generally a sterile salt solution, is introduced into your uterus.
Using a resectoscope or a hysteroscopic morcellator, your surgeon shaves sections off the fibroid and removes them from the uterus until the fibroid is fully gone. Large fibroids may not be completely removed in a single surgery, necessitating a second.
Outcomes of a myomectomy may include:
Symptomatic alleviation: Most women enjoy alleviation from troublesome signs and symptoms after myomectomy surgery, such as heavy menstrual bleeding and pelvic discomfort and pressure.
Fertility enhancement: Within a year following surgery, women who have a laparoscopic myomectomy, have a favourable pregnancy result. After a myomectomy, it is recommended that you wait three to six months before attempting to conceive to enable your uterus to recover.
Fibroids that your doctor does not find during surgery or fibroids that are not entirely removed may develop and cause problems in the future. New fibroids can form, which may or may not necessitate therapy. Women with a single fibroid have a reduced probability of acquiring new fibroids – known as the recurrence rate – than women with several tumours. Women who conceive following surgery have a decreased chance of acquiring new fibroids than women who do not conceive.
Women who have new or recurrent fibroids may have access to nonsurgical therapies in the future. These are some examples:
Embolism of the uterine artery (UAE). Microparticles are injected into one or both uterine arteries, restricting blood flow.
Volumetric thermal ablation using radiofrequency (RVTA). Radiofrequency radiation is used to wear away (ablate) fibroids by friction or heat, which is directed by an ultrasound probe, for example.
Focused ultrasonic surgery with MRI guidance (MRgFUS). Magnetic resonance imaging is used to guide the use of a heat source to ablate fibroids (MRI).
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