Myomectomy is a surgical procedure to remove uterine fibroids.
When is Myomectomy Indicated
Myomectomy is the treatment of choice in women with fibroids who are planning to have children in the future. This is indicated for large fibroids which are distorting the uterine cavity and for smaller submucosal (intra-cavitary) fibroids.
Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.
Depending on the size, location and number of fibroids, Dr Cook may choose one of three surgical approaches to remove the fibroids:
Hysteroscopic Myomectomy: This is performed to remove a fibroid which is growing into the cavity of the uterus. Hysteroscopic myomectomy is performed under general anaesthesia or spinal anaesthesia. Dr Cook uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Dr Cook can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Dr Cook may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that have not gone deep within the wall of the uterus can be removed using this technique.
Laparoscopic Myomectomy: A laparoscopic myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached with a camera is used. A small incision is usually made below the navel and a laparoscope is inserted through this incision. Carbon dioxide gas is injected into the abdominal cavity using a special needle to create more space to work. Dr Cook identifies and removes the fibroids. During the procedure, tissue samples can also be taken for biopsy. This procedure is the preferred option to remove one or two fibroids up to10 cm across that grow on the outside of the uterus.
An incision is made in the uterus over the fibroid. The fibroid in the uterus is removed and the uterus sutured laparoscopically. Dr Cook has the expertise to perform laparoscopic myomectomy. Few gynaecological surgeons have the skills necessary to perform this procedure.
Laparotomy: A laparotomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall Dr Cook may opt for laparotomy.
When is a Myomectomy Required?
Myomectomy is a treatment option if
you have anaemia and pain or pressure not relieved with medications.
the fibroid is causing bladder pressure and bladder irritability
the fibroids have changed the uterus so as to cause infertility or
repeated miscarriages as this method improves your chances of becoming pregnant even after the procedure.
the fibroid is so large as to cause abdominal swelling
Recovery from Myomectomy
After myomectomy surgery, your pelvic pain and bleeding from fibroids are reduced and your chances of having a baby are improved. If the fibroids are large and are more in number, they can re-grow after surgery.
Complications with Myomectomy
The possible complications of myomectomy include
scar tissue formation,
rupture of the uterine scars in late pregnancy or during labour - thus Caesarean delivery is often recommended
Rarely, a myomectomy causes uterine scarring that can lead to infertility.
Fibroids and Pregnancy
Fibroids can grow back. Those women who are planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, Dr Cook will advise you to wait 3 months until the uterus heals.
The incisions made in the wall of the uterus to remove fibroids may cause placental problems. A Caesarean delivery is recommended. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.