Myomectomy

Uterine fibroids affect millions of women worldwide, causing debilitating symptoms such as heavy bleeding, pelvic pain, and infertility. In the United States alone, approximately 200,000 women undergo surgical procedures annually to treat uterine fibroids, with myomectomy being a primary treatment option. A myomectomy, or a fibroidectomy, is a surgical procedure designed to remove these noncancerous growths, relieving discomfort and improving quality of life. Performed by skilled obstetricians and gynecologists, myomectomy techniques vary depending on the size, location, and number of fibroids, ranging from open abdominal surgery to minimally invasive laparoscopic or robotic-assisted procedures.

This article will delve into the indications, contraindications, procedure, recovery, and benefits of myomectomy for improved health and wellness. 

What is Myomectomy?

Myomectomy is a surgical procedure designed to remove uterine fibroids, noncancerous growths that develop in or around the uterus. Also known as a fibroidectomy, this operation aims to eliminate symptoms such as heavy menstrual bleeding, pelvic pain, and pressure while preserving the uterus and, in many cases, fertility. 

What Are the Types of Myomectomy?

There are several types of myomectomy, depending on the size, location, and number of fibroids. These include the following:

Classification by Surgical Approach

• Open myomectomy (abdominal myomectomy)
• Minimally invasive myomectomy
• Laparoscopic myomectomy
• Robotic-assisted myomectomy
• Hysteroscopic myomectomy
• Endoscopic myomectomy

Classification by Fibroid Location

• Intramural myomectomy (within the uterine wall)
• Submucosal myomectomy (within the uterine cavity)
• Subserosal myomectomy (on the outer surface of the uterus)
• Pedunculated myomectomy (fibroids attached by a stalk)

Classification by Fibroid Size

• Small fibroid myomectomy (<2 cm)
• Medium fibroid myomectomy (2-5 cm)
• Large fibroid myomectomy (>5 cm)

Classification by Surgical Technique

• Simple myomectomy (removal of a single fibroid)
• Intracapsular myomectomy (removal of fibroids within a capsule)
• Cavity-preserving myomectomy (preservation of the uterine cavity)
• Myomectomy with uterine reconstruction

What Are the Indications of Myomectomy?

Doctors may recommend myomectomy in the following cases:

Symptomatic Indications

• Heavy or prolonged menstrual bleeding (menorrhagia)
• Pelvic pain or pressure
• Abdominal bloating or distension
• Frequent urination or constipation
• Infertility or recurrent pregnancy loss
• Dysmenorrhea (painful menstruation)
• Dyspareunia (painful intercourse)

Asymptomatic Indications

• Large or rapidly growing fibroids
• Fibroids causing uterine distortion
• Fibroids impacting adjacent O
• Organs (e.g., bladder, bowel)
• Family history of fibroids or related conditions
• Plans for future pregnancy

Reproductive-Related Indications

• Infertility or difficulty conceiving
• Recurrent miscarriage or pregnancy loss
• Endometrial polyps or adenomyosis
• Uterine anomalies or malformations

What to Expect Before a Myomectomy?

Preparing for a myomectomy involves several steps to ensure a smooth and successful procedure. Here's a comprehensive checklist:

2-4 Weeks Before Surgery

• Schedule pre-operative appointments with your surgeon, primary care physician, and anesthesiologist.
• Complete blood tests, imaging studies (e.g., ultrasound, MRI), and other diagnostic tests as ordered.
• Stop hormonal medications, blood thinners, and certain supplements.
• Inform your surgeon about allergies, medical conditions, and medications.
• Arrange for someone to drive you home and assist with daily activities.

1-2 Weeks Before Surgery

• Review and sign surgical consent forms.
• Complete pre-surgical counseling and education.
• Plan for time off work (2-6 weeks).
• Prepare your home for recovery (e.g., clean and stock up on supplies).
• Stop smoking and refrain from heavy exercise.

1 Day Before Surgery

• Confirm surgery details (time, location, contact information).
• Review pre-surgical instructions.
• Fast from food and drink as instructed (usually 8-12 hours).

Day of Surgery

• Arrive at the hospital 1-2 hours before the scheduled surgery time.
• Bring identification, insurance cards, and contact information.
• Change into a hospital gown.
• Receive anesthesia and prepare for surgery.

Additional Tips

• Stay hydrated and eat nutrient-rich foods.
• Practice relaxation techniques (e.g., meditation, deep breathing).
• Have a support system in place.
• Keep a recovery journal to track progress.

How is a Myomectomy Performed?

A myomectomy is typically performed in a hospital or surgical center under general anesthesia, spinal anesthesia, or local anesthesia with sedation, depending on the type of procedure and patient's health. The surgery involves several steps:

Open Myomectomy

• Abdominal incision: A horizontal or vertical incision is made in the abdomen.
• Uterus exposure: The uterus is exposed and mobilized.
• Fibroid identification: The surgeon identifies and dissects the fibroid(s).
• Fibroid removal: The fibroid(s) are removed, and the uterine incision is closed.
• Uterine reconstruction: The uterus is reconstructed, and the abdominal incision is closed.

Laparoscopic Myomectomy

• Abdominal port insertion: Small incisions (keyhole) are made for laparoscopic ports.
• Uterus visualization: A laparoscope (a device with a light source and camera) visualizes the uterus.
• Fibroid identification: The surgeon identifies and dissects the fibroid(s).
• Fibroid removal: The fibroid(s) are removed through a laparoscopic port.
• Uterine reconstruction: The uterus is reconstructed, and the ports are closed.

Robotic-Assisted Myomectomy

• Abdominal port insertion: Small incisions (keyhole) are made for robotic ports.
• Uterus visualization: A robotic-assisted laparoscopy visualizes the uterus.
• Fibroid identification: The surgeon identifies and dissects the fibroid(s).
• Fibroid removal: The fibroid(s) are removed through a robotic port.
• Uterine reconstruction: The uterus is reconstructed, and the ports are closed.

Hysteroscopic Myomectomy

• Cervical dilation: The cervix is dilated.
• Hysteroscope insertion: A hysteroscope (camera) is inserted through the cervix.
• Fibroid identification: The surgeon identifies and dissects the fibroid(s).
• Fibroid removal: The fibroid(s) are removed through the hysteroscope.
• Uterine reconstruction: The uterus is reconstructed.

What to Expect While Recovering After a Myomectomy?

Recovery after myomectomy typically involves:

Immediate Post-Surgery (1-2 Days)

• Hospital stay: 1-2 days (open myomectomy), outpatient (laparoscopic/robotic-assisted)
• Pain management: Medication such as NSAIDs and monitoring
• Rest as much as possible
• Optimal fluid intake: Encouraged to prevent dehydration
• Urinary catheter: May be inserted to monitor urine output

Short-Term Recovery (1-2 Weeks)

• Rest: Avoid heavy lifting, bending, or exercise
• Pain management: Continue medication as directed
• Follow-up appointments: Monitor healing and remove sutures/staples
• Wound care: Keep the incision site clean and dry
• Dietary restrictions: Avoid heavy or spicy foods

Medium-Term Recovery (2-6 Weeks)

• Gradual return to normal activities
• Exercise: Gentle stretching, walking, or yoga
• Driving: Avoid heavy braking or acceleration
• Lifting: Limit to 10-15 pounds
• Intercourse: Avoid for 6-8 weeks

Long-Term Recovery (6-12 Weeks)

• Full return to normal activities
• Exercise: Gradually increase intensity and duration
• Fertility: May resume trying to conceive after 3-6 months
• Menstrual cycle: It may take 4-6 weeks to regulate
• Follow-up appointments: Monitor for potential complications

Final Thought

Myomectomy is a life-changing surgical procedure for women suffering from uterine fibroids, offering relief from debilitating symptoms and improved quality of life. Women can make informed decisions about their reproductive health by understanding the types, indications, and recovery process. With advances in minimally invasive techniques and robotic-assisted surgery, myomectomy has become a safer and more accessible option. 

Ultimately, consulting a healthcare provider and weighing the benefits and risks enables women to take control of their well-being and make empowered choices about their reproductive health.

FAQs

1. Can You Get Pregnant After Myomectomy?

Yes, you can get pregnant after a myomectomy. However, the likelihood of conception varies depending on individual factors. Studies show that 50-70% of women with infertility issues due to fibroids achieve pregnancy within 1-2 years after surgery. 

2. Do Fibroids Come Back After Myomectomy?

Fibroids can recur after myomectomy, but the likelihood varies. Studies suggest that 20-30% of women experience fibroid recurrence within 5 years after surgery. However, this depends on factors like age, number, and size of fibroid removed, type of survey, and hormonal influences.