Myomectomy
What Is A Myomectomy?
A myomectomy is a surgical procedure that removes uterine fibroids (benign tumours that grow in the uterus muscle) while preserving the uterus.
It is typically performed by a gynaecologist and can be done through a variety of techniques, including laparotomy (an open abdominal surgery), laparoscopy (minimally invasive surgery using small incisions), or hysteroscopy (surgery performed through the cervix).
The choice of technique will depend on the size, location, and number of fibroids, as well as the patient's overall health and preferences. Recovery time varies depending on the method used, but most women can return to normal activities within a few weeks.
Common Names for Myomectomy
Myomectomy is the medical term for the surgical removal of uterine fibroids. Some other common names for this procedure include:
- Fibroid removal surgery
- Uterine fibroid surgery
- Fibroidectomy
- Uterine myomectomy
- Leiomyoma resection
- Myoma resection
Who Is Suitable For A Myomectomy?
Myomectomy is typically recommended for women with symptomatic uterine fibroids who wish to preserve fertility. It may be suitable for women who experience heavy or prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, or difficulty becoming pregnant.
The following factors are considered when determining if myomectomy is suitable for a patient:
- Size, location, and number of fibroids
- Patient's age and overall health
- Patient's desire to have children
- Patient's preference for preserving the uterus
- Feasibility of the procedure based on the location of the fibroid
Myomectomy is not recommended for women with cancerous growths in the uterus or those who have completed their childbearing and wish to undergo a hysterectomy.
What Are The Benefits of Myomectomy?
Myomectomy offers several benefits for women who have symptomatic uterine fibroids and wish to preserve their fertility:
- Relief of symptoms: Myomectomy can alleviate heavy or prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, and difficulty becoming pregnant caused by fibroids.
- Preservation of fertility: By removing the fibroids without damaging the uterus, myomectomy allows women to become pregnant and carry a pregnancy to term.
- Preservation of the uterus: Myomectomy preserves the uterus, which is important for women who wish to maintain their reproductive function or have a strong emotional attachment to their uterus.
- Minimally invasive option: Laparoscopic and hysteroscopic myomectomies are minimally invasive options and have less recovery time and less risk of complications as compared to open surgery.
- Return to normal activities: Recovery time after a myomectomy is generally shorter than after a hysterectomy, and most women can return to normal activities within a few weeks.
Types Of Myomectomy
The type of Myomectomy depends on the size and site of the fibroid. There are several types of Myomectomy. These include:
- Hysteroscopic Myomectomy: When the fibroid is mainly within the uterine cavity, it can be removed hysteroscopically by inserting a long thin camera through the cervix into the uterus. The fibroid is then cut away and removed through the cervix and vagina.
- Laparoscopic Myomectomy: This is the removal of Fibroid(s) in the uterine muscle via keyhole surgery.
- Open Myomectomy: Myomectomy is the removal of Fibroids followed by repair of the uterus. This is performed as an open (laparotomy) procedure. The open approach is often preferred for larger lesions.
What Are The Alternatives To A Myomectomy?
There are several alternatives to a myomectomy for treating symptomatic uterine fibroids, including:
- Hysterectomy: A hysterectomy is the surgical removal of the uterus. This is the most effective treatment for fibroids, but it is also the most invasive, and it makes the patient unable to have biological children.
- Uterine artery embolisation (UAE): This minimally invasive procedure blocks the blood flow to the fibroids, causing them to shrink. It's a good option for women who don't want to have surgery and have completed their childbearing.
- Medications: Certain medications, such as Gonadotropin-releasing hormone (GnRH) agonists, can shrink fibroids, but they are not a permanent solution and can have side-effects.
- Watchful waiting: Watchful waiting may be suitable for women if their fibroids are not causing symptoms, with small fibroids or mild symptoms. They will be monitored for changes to the fibroids and symptoms over time.
What is the impact of Fibroids on Fertility
The location, size and number of fibroids determines if they are likely to cause any impact on fertility. Generally speaking:
- Submucosal fibroids: these are within the uterine cavity. Submucosal fibroids are thought to negatively impact the chance of conceiving and are associated with an increased rate of miscarriage. A Hysteroscopic myomectomy (as a day surgery procedure) can often be effective at removing submucosal fibroids.
- Intramural fibroids: these are fibroids within the muscle layer of the uterus. In many instances they will not have a major impact on your chance of conceiving unless they are large and multiple in number. These will require major surgery (either via keyhole or open surgery) to remove.
- Subserosal fibroids: these fibroids on the outer layer of the uterus. They are generally not are not thought to have any major impact on the chance of conceiving and may not require surgical removal (unless symptoms other than infertility are present).