Myomectomy is a surgical procedure to remove uterine fibroids, which are benign or non-cancerous growths appearing in your uterus
Many women with uterine fibroids do not experience any symptoms. However, some women may experience symptoms such as heavy and prolonged menstrual bleeding, anaemia due to heavy menstrual bleeding, pelvic pain, lower back pain, or bloating of the abdomen. In other cases, women may have difficulty emptying the bladder, difficulty moving the bowels, and reproductive problems such as infertility.
Myomectomy is the treatment of choice in women with problematic fibroids who are planning to have children in the future. Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy. You may need to have a caesarean section after a myomectomy.
Preparation before Surgery
Before your surgery, gonadotropin-releasing hormone analogue (GnRH-a) therapy which lowers oestrogen levels may be used to shrink the uterine fibroids, thus reducing the risk of excessive bleeding during the surgery.
Indications for Myomectomy
A myomectomy is a treatment option if you have problematic fibroids but you want to keep your uterus (other women may choose to have a hysterectomy for their fibroids). Myomectomy is also done if the fibroids have changed the shape of the uterus so as to cause infertility or repeated miscarriages as this method improves your chances of becoming pregnant even after the procedure. After myomectomy surgery, your bleeding from fibroids is usually reduced and your chances of having a baby may be improved. If the fibroids are large and are more in number, they can re-grow after surgery.
Depending on the size, location, and a number of fibroids, your surgeon may choose one of three surgical approaches to remove the fibroids:
- Hysteroscopy: This is an outpatient surgical procedure and is performed under general anaesthesia or spinal anaesthesia. Your doctor uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Your doctor can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Your doctor may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that are not too deep within the wall of the uterus can be removed using this technique
- Laparoscopy: A laparoscopic myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached with 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 using a special needle to create more space to work. Your surgeon 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 small to moderate size fibroids that grow on the outside of the uterus. Dr Alice Whittaker doesn’t currently perform laparoscopic myomectomy but if this is your preferred option and if it is appropriate to your case, she can refer to a colleague who does perform this operationg, and Dr Whittaker can assist with your surgical case.
- Laparotomy: A laparotomy for myomectomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall your doctor may opt for laparotomy. Urinary or bladder problems can be corrected using laparotomy
The possible complications of myomectomy include bleeding, infection, scar tissue formation, damage to the bladder , bowel or ureters, and rupture of the uterine scars in late pregnancy or during labour. Rarely, a myomectomy causes uterine scarring that can lead to infertility
Because fibroids can grow back, those women who are planning to become pregnant in the future should try to conceive soon after the myomectomy procedure. However, your doctor will usually advise you to wait for 4 to 6 months until the uterus heals. Before undergoing any treatment for infertility, your doctor may recommend a hysterosalpingogram, an X-ray test to check the uterus and fallopian tubes.
The incisions made in the wall of the uterus to remove fibroids may cause placental problems and improper functioning of the uterus during labour may need a caesarean delivery. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.