Myomectomy Surgery For Uterine Fibroids

Uterine fibroids can be removed by surgeons through a technique called a myomectomy. 

Uterine fibroids, sometimes called leiomyomas, are surgically removed from the uterus during this surgery. Muscle and connective tissue cells combine to form fibroids, which are growths. They may show up within or outside of your uterus. virtually always free of cancer (benign). You may have one, several, or different-sized fibroids. The uterine tissues are preserved during removal of fibroid so that you can have children in the future while the fibroids are removed by your surgeon. A myomectomy is an alternative to hysterectomy, which involves the removal of your uterus, cervix, and fibroids.

Can I avoid myomectomy?

Small fibroids or myoma usually goes unnoticed. At times they are discovered during an abdominal ultrasound done for other complaints. In this case, you may need a gynecologist opinion.  These small fibroids without any complaints are just followed up with an ultrasound every six months. If there is any rapid growth or heavy menstrual bleeding or pain ensues you may need this surgery. If you are nearing menopause and don’t have any of these complications, your doctor will advise not to go for myomectomy.

When will I need a Myomectomy?

If you have uterine fibroids that are resulting in any of the following symptoms:

  • Ache in the pelvis.
  • Bleeding irregularly or in between cycles.
  • Heavy bleeding during the period.
  • Unable to completely empty your bladder

If you want to keep your fertility and hope to get pregnant in the future, myomectomy surgery is a good option.

What are other treatment options if I have fibroids?

There are many different types of uterine fibroids, and some don’t need to be treated. Your medical care is dependent on the following:

  • The quantity, size, and location of fibroids.
  • What you prefer (desire to become pregnant in the future or have a menstrual period).

Medical management

Another method for treating uterine fibroids is medication. Medication may help with fibroids’ symptoms and help them become smaller. There are few medications available which need therapy for months. Few of the fibroids shrink making your heavy periods regular and alleviate the pain. However, these effects may not last longer, eventually requiring removal.

Surgical Management

The available surgical methods are few. It depends on the wish to retain the reproductive capacity. Myomectomy is advised when women want future fertility or menstruation. Uterine artery embolisation and radiofrequency ablation are two more therapy possibilities. The complicated cases or women past child bearing age can choose for hysterectomy or removal of uterus. 

What is the cost of myomectomy surgery?

Cost of the surgery usually depends on the associated problems with the myoma. A complicated fibroid like a large one with adhesions all around will take a lot of precaution, meticulous surgery and long surgical hours. Similarly multiple fibroids take a lot of surgical intervention. In addition, fibroids nearer to a vessel may bleed profusely. Hence, may need assistance from a vascular surgeon. In addition, myoma having bowel adhesion needs a gastro surgeon on standby. At times during surgery your bladder or ureter may get injured and needs a urologist to intervene. Hence cost of myomectomy varies in different scenarios. Usually, open myomectomies are charged 50,000 to 70,000 rupees whereas laparoscopy cases are costlier. 

Type of surgeryNumber of fibroidsComplicationsCost (INR)
Open MyomectomySingle or multiple fibroid, any sizeBleeding,Injury to organs50,000 – 70,000
Laparoscopic Large, singleThermal injury of bowel, bladder85,000 – 120,000
Hysteroscopic Single or fewBleeding, Rupture of uterus70,000-90,000
Robotic assistedSingle or fewInjury to other organs100,000-120,000

What’s the difference between a myomectomy and a hysterectomy?

The primary distinction between the two treatments is that just the fibroids are removed during a myomectomy, leaving your uterus intact. You can become pregnant later on and your menstrual cycle will return. Your uterus and fibroids are removed during a hysterectomy. As a result, hysterectomy patients can no longer become pregnant and won’t have menstruation.

Is it the same as the C section?

No, C- section or Cesarean section is an open procedure to deliver the baby. But myomectomy can be done in different ways to remove the fibroid from your uterus. 

There are, in fact, three basic categories of myomectomy:

  • Open hysterectomy (or abdominal myomectomy).
  • Minimally invasive procedure using laparoscopic or robotic surgery
  • Myomectomy using hysteroscope.

The following are some of the considerations that go into choosing the type of myomectomy to have. 

  • Small Vs large size
  • Single or multiple fibroids
  • In the muscle layer/into the cavity or outside

What happens to the menstrual cycle after myomectomy?

  You will resume your normal menstrual cycles after the surgery. It may be irregular for the first few months. If you have a very large fibroid with an enlarged uterus, it will take some time for the uterus to shrink. Till then you may experience heavy bleeding or mild pain. Your doctor may advise you to take pills for a few months to avoid these complaints happening.

Can I conceive after myomectomy?

Myomectomy is a fertility conserving surgery and many women conceive and give childbirth without any problems. However pregnancy after myomectomy needs continuous monitoring. In very few instances the scar of surgery may rupture complicating the pregnancy. Some women may have infection of the wound leading to fallopian tubal blockage. These women may need IVF treatment for conceiving.

Types of Myomectomy procedure

Open myomectomy

With a belly cut (incision), a doctor performs an open myomectomy (abdominal myomectomy) (abdomen). The incision could be horizontal or vertical, going across (horizontal). Because to the surgeon’s ability to see all of your pelvic organs, this operation may be the best choice for really big fibroids. However, an open myomectomy recovers similarly to any other major operation. Following recovery

  • Several days spent in the hospital.
  • Before feeling completely better, you could spend up to six weeks at home.

Minimally invasive laparoscopic myomectomy

A myomectomy can be performed using a variety of minimally invasive techniques. In general, these procedures are simpler on your body and have shorter recuperation times.

Laparoscopic or robotic myomectomy:

During this treatment, your surgeon inserts a tiny, illuminated telescope through your belly button. Your surgeon will next make many more minor incisions in your belly, inserting surgical instruments to help them remove the fibroids. For this kind of surgery, some surgeons employ a robot to direct the movement of their instruments (robotic myomectomy).

Single port myomectomy

For all the surgical equipment used in this procedure, there is just one entrance close to your belly button. Your belly button receives a slightly larger incision as a result, but your abdomen is left undisturbed.

Hysteroscopic myomectomy: 

This operation doesn’t even call for any incisions. Your surgeon can remove fibroids when they are located in the uterine cavity. Besides, your doctor removes it by inserting a camera with a specialized attachment through the vagina and into your uterus.

What are some of the risks of myomectomy?

Possible complications of a myomectomy can include:

  • Bleeding.
  • Infection.
  • Blood clots.
  • Damage to nearby organs.
  • Allergic reactions to anaesthesia.
  •  Needing a C-section delivery increases the risk

These complications are uncommon, and your healthcare team will make every effort to avoid these problems.

When should I see my healthcare provider?

Contact your doctor if you have any of the following signs after having a myomectomy to remove fibroids:

  • Heavy bleeding.
  • Chills, a fever, or other flu-like symptoms.
  • Medications are unable to treat your pain.
  • Breathing problems or chest aches.
  • Legs that are red, puffy, or cramping.

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