Myomectomy Surgery
Surgical Fibroid Removal
What is myomectomy?
Myomectomy surgery is a type of open surgery to remove fibroids while preserving the uterus. There are different types of myomectomies, with the common objective of selectively removing the fibroids to relieve associated bleeding, urinary, and/or pain symptoms.
An abdominal myomectomy, also known as “open myomectomy”, involves a single 4-inch incision in the lower abdomen known as a “bikini cut”, followed by removal of the fibroids from the wall of the uterus. The uterine muscle is then sewn back together. The patient is asleep during the myomectomy procedure. Blood loss during the procedure may require a transfusion, and some women choose to store blood before the operation in order to receive their own blood rather than blood from a blood bank. The patient will spend a few nights in the hospital, and recovery at home typically lasts 4-6 weeks. A four-inch horizontal scar will remain near the “bikini” line.¹
A laparoscopic myomectomy allows your surgeon to remove the fibroids through several small 1-centimeter incisions in the lower abdomen, rather than one 4-inch incision such as in the abdominal myomectomy. This technique is less invasive and recovery is faster than with abdominal myomectomy. During the procedure the abdomen is filled with carbon dioxide gas in order to create a working and viewing space. The laparoscope is a thin instrument used to visualize the ovaries, fallopian tubes, and uterus. Other thin surgical instruments are then used to surgically remove the fibroids. At the end of the procedure the gas is released and the skin incisions are closed. Most patients will spend one night in the hospital followed by 2-4 weeks recovering at home. The patient will have four small scars where the myomectomy incisions were made.¹
A hysteroscopic myomectomy is typically only done for submucosal and intra-cavity fibroids. If the fibroids are located within the uterine wall, this technique cannot be used. During this myomectomy procedure your surgeon uses a special scope to remove the fibroids through the vagina and cervix.
Hysteroscopic or Vaginal
Fibroid removal directly through the vagina.
Laparoscopic Myomectomy
Fibroid removal through multiple small abdominal incisions.
Abdominal Myomectomy
Fibroid removal through incisions in the abdomen.
How does myomectomy work?
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Knowing that fibroids are the direct cause of urinary, bleeding, and/or pain symptoms, surgical removal of the fibroids (via any of the aforementioned methods) has been shown to relieve these symptoms.
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Is myomectomy clinically proven?
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Myomectomy has been clinically proven as safe and effective in significantly reducing symptoms caused by uterine fibroids, with similar patient satisfaction outcomes to both hysterectomy and uterine fibroid embolization.²
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How does myomectomy compare to other treatment options?
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The primary (and obvious) advantage of myomectomy is the retention of the uterus, and thus the possibility of future pregnancy. However, like any surgical procedure, myomectomy may have complications including bleeding, scarring of the uterus, or fibroid regrowth. One study compared outcomes in 149 UFE and 60 myomectomy patients across 16 medical centers in the US, and found similar improvements in fibroid symptoms and quality of life. The only differences were that patients receiving UFE required fewer days off work (10 versus 37 days) and experienced fewer adverse events, major or minor (22% vs 40%).³
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Is myomectomy right for me?
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Several factors should be discussed with your physician before deciding on myomectomy. These include but are not limited to: the patient’s age, the size and number of fibroids, the patient’s desire to remain fertile, and desired time to return to normal activities. If you're considering fibroid treatment, we recommend that you familiarize yourself with all of your options. Contact us to discuss a myomectomy in Los Angeles today.
References
[1] Rakotomahenina, H., Rajaonarison, J., Wong, L., & Brun, J.-L. (2017). Myomectomy: technique and current indications. Minerva Ginecologica, 69(4), 357–369.
[2] Younas K, Hadoura E, Majoko F, Bunkheila A. A review of evidence-based management of uterine fibroids. The Obstetrician & Gynaecologist 2016;18:33–42.
[3] Goodwin SC, Bradley LD, Lipman JC. UAE versus Myomectomy Study Group. Uterine artery embolisation versus myomectomy: a multicenter comparative study. Fertil Steril 2006;85:14–21.