Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.
The fibroids needed to be removed are typically large in size, or growing at certain locations such as bulging into the endometrial cavity causing significant cavity distortion. A myomectomy can be performed in a number of ways, depending on the location and number of lesions and the experience and preference of the surgeon. Either a general or a spinal anaesthesia is administered.
Using the laparoscopic approach the uterus is visualized and its fibroids located and removed. Development of new fibroids will be seen in 42-55% of patients undergoing a myomectomy. It is well known that myomectomy surgery is associated with a higher risk of uterine rupture in later pregnancy.
Myomectomy :surgically removes fibroids from the uterus. The uterus is left intact and this increases the chances of pregnancy in women who have had difficulties in conception.
Before undertaking the procedure the fibroids are made to shrink by giving treatment with fibroids with gonadotropin-releasing hormone analogue (GnRH-a). This helps is reduction of blood loss during the procedure
There are 3 surgical methods for myomectomy.:
These are Hysteroscopy,( inserting a lighted viewing instrument through the vagina and into the uterus.), Laparoscopic method uses lighted viewing instrument with cutting incisors in the abdomen and Laparotomy procedure involves larger incision in the abdomen. The type of method to be used is to be individualised based on the size, location, and number of fibroids.
Hysteroscopy can be used to remove superficial fibroids on the inner wall of the uterus and is an outpatient procedure. Laparoscopy is used for removing deeper fibroids and also those that are growing across and on the outside of the uterus. Laparoscopy is also an outpatient procedure. In few cases hospitalization for a day could be required.
Laparotomy is used to remove large fibroids, many fibroids, or fibroids that have grown deep into the uterine wall. These require hospitalization from around 2-5 days depending on the scope and extend of the procedure. Recovery periods are variable based on the type method used. Hysteroscopy requires from a few days to 2 weeks recovering whereas Laparoscopy and Laparotomy requires 1- 2 weeks and 4 to 6 weeks respectively.