Fibroids
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Health Information
Myomectomy
Myomectomy is a surgical procedure that allows
the gynecologic surgeon to both remove the fibroids
and reconstruct the uterus after doing so. This
is a preferred option for women who want to avoid
a hysterectomy, the complete removal of the uterus.
It's also preferred by the physician when there
are multiple fibroids or the fibroids are large.
Although myomectomy relieves pelvic pressure
and, in most cases, restores normal menstrual
flow, it does not "cure" fibroids. As
long as the uterus is still intact and estrogen
still circulating, fibroids can return. In fact,
fibroids reappear in about 30% of women who have
undergone a myomectomy.
Depending on the location and size of the fibroids,
there are several ways to remove them during a
myomectomy: abdominally (traditionally), laparascopically
or hysteroscopically.
Abdominal myomectomy involves an incision through
the abdomen to reach the uterus and remove the
fibroid(s). In the past, because it was longer
and carried a greater risk of blood loss, myomectomy
was considered a more difficult procedure than
a hysterectomy. Today, however, a myomectomy is
considered just as safe as a hysterectomy. Since
it's performed abdominally though, it's still
considered major surgery and it will take some
time for a patient to fully recover. It is possible
that following an abdominal myomectomy, the doctor
may instruct the patient to undergo a Caesarean
section with subsequent deliveries. Consult with
your physician about this issue.
When the fibroid is located on the outside of
the uterus, the surgeon can often reach it laparoscopically,
through a small incision in the navel rather than
a large incision in the abdomen. This procedure
is known as laparoscopic myomectomy. A laparoscope,
which is a thin telescope-like instrument, is
inserted through an incision in the navel. This
allows the surgeon a direct view into the pelvic
area. While the surgeon views the fibroids through
the laparoscope, he/she guides thin tubes fitted
with surgical instruments toward the fibroids
and removes them. As with abdominal myomectomy,
physicians may tell women who've had laparoscopic
myomectomy to undergo a Caesarean section with
subsequent deliveries. Consult with your physician
about this issue.
If the fibroids protrude into the cavity of the
uterus, a hysteroscopic myomectomy may be a good
option. In this outpatient procedure, an abdominal
incision is avoided, making recovery easier. The
surgeon inserts a hysteroscope, or a thin telescope-like
instrument that can be fitted with special surgical
tools, through the vagina and into the uterine
cavity to remove the fibroids.
Several techniques have been developed to make
myomectomies easier to perform.
- Gonadotropin Releasing Hormone Analogues (GnRH
Analogues) are synthetic hormones that can be
taken prior to surgery to reduce the size of
the fibroids and make them easier to remove.
- A diluted solution of Vasopressin can be injected
into the uterus during surgery, causing the
blood vessels to narrow, and thereby reducing
the amount of bleeding.
- Electrical cautery devices or lasers can be
used as cutting tools instead of a scalpel or
scissors. This reduces the amount of bleeding
during surgery.
- A tourniquet may be placed around the uterus
to prevent bleeding during surgery.
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