MYOMECTOMY

What is Myomectomy?

  • A myomectomy is the surgical removal of benign tumors called fibroids (also known as myomas) from the muscular wall of the uterus.
  • It allows the uterus and all reproductive organs to be left in place, improving the chances of being pregnant for some women (but not guaranteed).
  • The kind of myomectomy performed depends on the type, size, number and location of the fibroids.
  • As per the location of the fibroids, myomectomy can be conducted through the pelvic area or the vagina and cervix.

What are the different ways that myomectomy is performed?

Depending on the type, size, number, and location of the fibroids, surgeons use different surgical approaches such as minimally invasive laparoscopic surgery or open abdominal surgery.

Open Myomectomy –

  • It requires either making a vertical incision from just below the navel to the pubic bone or a horizontal incision above the pubic bone.
  • The benefit of this procedure is that all fibroids can be removed from all of the places, and the uterus can be adequately closed so that it can heal before attempting to conceive a child.

Laparoscopic or Robotic Myomectomy –

  • It’s a minimally invasive procedure to remove fibroids from the outside of the uterus.
  • It requires making some small incisions, which allow access to different instruments to the uterus.
  • The fibroids are removed, and the small incisions are sutured (sewn) closed.

Hysteroscopic myomectomy –

  • In this procedure the fibroids are removed through the dilated cervix, so no abdominal incisions are needed.
  • The instrument called a resectoscope (a hysteroscope fitted with a wire loop) is inserted through the cervix, and the wire loop hung over the fibroid.
  • The electrical energy passes through the loop cutting the fibroid loose which can then be removed through the vagina.

Laparoscopically Assisted Abdominal Myomectomy with Bilateral Uterine Artery Occlusion (LAAM-BUAO) –

  • It is a minimally invasive procedure to remove fibroids from the outside of the uterus.
  • LAAM involves the best elements of both laparoscopic and open approaches for fibroid removal.
  • It requires two tiny incisions, one at the bikini line and one at the belly button, and it can be done on any patient regardless of the size, number, or location of the fibroid.
  • Bilateral Uterine Artery Occlusion (BUAO) is the blockage of the uterine artery during the procedure to control bleeding.

When is Myomectomy used?

  • The myomectomy is performed to remove fibroids that are preventing the uterus from becoming pregnant or to preserve the uterus for pregnancy.

What are the preparations to be done before the procedure?

  • Ultrasound – It is must, to have a pelvic ultrasound to determine the size, number, and location of the fibroids before the procedure.
  • Laboratory evaluation – A complete blood count (CBC) is necessary. Blood loss with myomectomy is more compared to other processes. A pregnancy test and electrolytes should also be obtained.
  • Types of surgical procedures for myomectomy – Based on the kind, size, number and the location of the fibroids the suitable type of myomectomy procedure is selected to be performed.

What is the necessary treatment process?

  • To prepare you for the process a sedative (medicine) or anesthesia will be administered to numb the area, to help you relax, or to help you sleep.
  • Then according to the type of surgical approach selected (as discussed above) the treatment proceeds.