Myomectomy: Procedure, Types, Benefits & Recovery Guide

What is a myomectomy?

Myomectomy is derived from the terms myoma (fibroid) and ectomy (removal). It is a fibroid removal procedure for the uterus. Fibroids are growths composed of connective tissue and muscle cells. They can appear both inside and outside the uterus and are usually always benign (not malignant). You can have one or several fibroids of varying sizes.

When a woman wishes to maintain her ability to have children and has fibroids, a myomectomy is usually the best option because it removes the fibroids while preserving the uterus.

Symptoms Addressed by Myomectomy

Certain symptoms that are relieved by Myomectomy include;

Heavy Menstrual Bleeding (Menorrhagia): Myomectomy can effectively treat excessive menstrual bleeding, a common symptom of fibroids. 

Irregular Bleeding: Fibroids can disrupt the menstrual cycle, resulting in irregular bleeding or bleeding between periods. Myomectomy can help reestablish a more consistent menstrual cycle.

Pelvic Pain and Pressure: Fibroids can cause pain and pressure in the pelvis, particularly during menstruation. Myomectomy can relieve these problems. 

Frequent Urination or Difficulty Urinating: Large fibroids might cause frequent urination or trouble emptying the bladder. Myomectomy can help with these urinary difficulties.

Constipation: Fibroids can place strain on the intestines, leading to constipation. Myomectomy can lower the pressure and enhance gut function.

Infertility or Recurring Miscarriages: In rare circumstances, fibroids can impair fertility or contribute to recurrent losses. Myomectomy can improve reproductive health while lowering the likelihood of these problems.

Iron-Deficiency Anemia: Heavy menstrual flow from fibroids can induce iron-deficiency anemia. Myomectomy can help to minimize blood loss and increase iron levels.

Also Read: Fibroids: Treatment, Causes, Symptoms

Types of Myomectomy

Open (Abdominal) Myomectomy: An open myomectomy requires making an incision in the abdominal wall to access the uterus and remove fibroids. It is commonly used for bigger fibroids or when several fibroids are present.

Laparoscopic Myomectomy: This minimally invasive technique removes fibroids from the abdomen using small incisions and specialized devices. It provides advantages such as less pain and faster recovery compared to open surgery. 

Hysteroscopic Myomectomy: Hysteroscopic myomectomy involves removing submucosal fibroids from the uterus through the cervix with a thin, flexible hysteroscope. It is a minimally invasive procedure that leaves little scarring and allows for a faster recovery.

Robotic Myomectomy: This is a type of laparoscopic myomectomy in which the surgeon employs a robotic system to operate instruments with higher precision and dexterity. It can provide advantages such as reduced blood loss and faster recovery than regular laparoscopic surgery. 

Also Read: How to get pregnant with uterine fibroids?

Preoperative Preparation for Myomectomy

Your doctor will tell you about any preparations you should make before surgery. This includes directions on when to cease eating and drinking, as well as whether or not to discontinue certain medications.

Your doctor will also go over post-operative instructions, such as how long you may expect to be in the hospital post surgery and what lifestyle changes you should make while recovering.

The Myomectomy Procedure

On the day of operation your doctor will put an intravenous line (IV) into a vein in your arm or hand. This provides fluids and medications during surgery. You are also given anesthetic via an IV so that you do not experience pain during the surgery.

During surgery, your provider will attach monitors that will measure your heart rate and other critical signs. Your doctor may also place a catheter to empty your bladder during surgery.

The method used will vary based on the type of myomectomy procedure you are undergoing, such as:

Abdominal Myomectomy

You will be given general anesthesia for this surgery. Your surgeon will create an incision through your lower abdomen and into your uterus.

This can be done in a number of ways:

• A horizontal incision about 3 to 4 inches long, directly above your pubic bone. This sort of incision is less painful and leaves a smaller scar, but it may be insufficient to remove large fibroids.

• A vertical incision that runs from just below your belly button to just above your pubic bone. This form of incision is rarely utilized anymore, but it may be more effective for bigger fibroids to minimize bleeding. Once the incision is done, the surgeon will remove the fibroids from your uterine wall. Then they will sew your uterine muscle layers back together.

Most women who undergo this operation spend one to three days in the hospital.

Laparoscopic Myomectomy

While you are under general anesthesia, your surgeon will make four small incisions. These will be approximately ½-inch long in your lower abdomen. Your stomach will be filled with carbon dioxide gas to allow the surgeon to see inside your abdomen.

The surgeon will next insert a laparoscope into one of the incisions. A laparoscope is a slender, illuminated tube with a camera at one end. Small instruments will be inserted into the remaining incisions.

If you have a robotic surgery, your surgeon will use a robotic arm to control the instruments remotely.

Your surgeon may slice your fibroids into little pieces before removing them. If they are excessively large, your surgeon may perform an abdominal myomectomy, which involves a larger incision in your abdomen. Your surgeon will then remove the instruments, release the gas, and close the incisions. 

Most women who undergo this operation stay in the hospital for one night.

Hysteroscopic Myomectomy

This operation will require either a local anesthetic or general anesthesia. The surgeon will slide a small, illuminated scope through your vagina and cervix into your uterus. They will also put a liquid into your uterus to enlarge it and allow them to see your fibroids more clearly. Following this, your surgeon will use a wire loop to remove portions of your fibroid. The liquid will then wash out the fibroid bits that were removed.

You should be able to go home the same day you have this surgery.

Also Check: How to get pregnant with hormonal imbalance?

Benefits of Myomectomy

The primary benefit of myomectomy is that it retains fertility, allowing patients to become pregnant following fibroid removal. If fibroids are keeping you from getting pregnant, the treatment may potentially help. 

Risks and Complications Associated with Myomectomy

The potential risks of a myomectomy may include:

• Bleeding
• Infection
• Blood clots
• Damage to neighboring organs
• Allergic reactions to anesthesia
• Increased likelihood of requiring a C-section birth

These consequences are infrequent, and your medical team will make every effort to prevent them.

Also Read: When is IUI suggested as the first line of treatment?

Recovery After Myomectomy

The recovery time after myomectomy is determined by the type of procedure performed. It also depends on whether any complications occur. You can anticipate some pain in the first few days, for which your doctor will offer you pain medicines. They will additionally encourage you to exercise your legs or take short walks following surgery to avoid blood clots.

It can take up to six weeks to fully recover after an open myomectomy and resume routine activities.

You may be able to go home the same day after having a laparoscopic myomectomy. Recovery at home takes roughly two to four weeks.

If the surgery is performed hysteroscopically (via your vagina without incisions), full recovery may take place in a matter of days.

Fertility and Pregnancy Considerations Post-Myomectomy

The kind and quantity of fibroids determine your chances of becoming pregnant. Women who have had more than six fibroids removed are less likely to become pregnant compared to those who have had fewer fibroids removed.

Because this operation weakens your uterus, there is a risk that it will tear as your pregnancy advances or during labor. Your doctor will most likely propose that you have a cesarean delivery to avoid this issue. They may recommend scheduling this close to your actual due date.

Your cesarean delivery may be possible to be conducted through your myomectomy incision site. This can help lessen the number of scars you have.

Also Read: How Does Pelvic Inflammatory Disease Cause Infertility?

Conclusion

Your doctor may suggest a myomectomy to remove uterine fibroids that are causing symptoms such as irregular vaginal bleeding and pelvic pain. The sort of myomectomy you will undergo is determined by the size and location of the fibroids. It is not the only approach to treat fibroids, so see your doctor about the risks and benefits of the surgery before undergoing it.

FAQ’s on Myomectomy