A Uterus-Friendly Approach to Fibroid Removal
What is myomectomy?
Myomectomy is a surgical procedure that removes uterine fibroids (benign growths in the uterus) while keeping the uterus intact. Gynecologic Surgeon or Minimally Invasive Gynecologic Surgeon performs to relieve symptoms like heavy menstrual bleeding, pelvic pain, or infertility. Myomectomy is a procedure of choice for women who have fibroids and do not wish to have a hysterectomy. Experienced gynaecological surgeons perform myomectomy through a keyhole (laparoscopic) or open abdominal surgery. Laparoscopic myomectomy is a complex laparoscopic surgery whose success depends on knowledge and competence.
Uterine Fibroids-Effects on Pregnancy
Types of Myomectomy:
- Abdominal Myomectomy: Open surgery with an incision in the lower abdomen.
- Laparoscopic Myomectomy: Minimally invasive, using small incisions and a camera.
- Hysteroscopic Myomectomy: Performed through the vagina and cervix for fibroids inside the uterine cavity.
Benefits:
- It preserves the uterus, making it suitable for women who want to conceive.
- Relieves symptoms while avoiding a hysterectomy.
Risks:
- Bleeding and infection.
- Scar tissue formation.
- Potential for fibroids to regrow.
What Precisely Are Uterine Fibroids?
Uterine fibroids, called leiomyomas or myomas, are non-cancerous growths in or around the uterus. These are composed of muscle and fibrous tissue growing from the smooth muscle layer of the uterus (myometrium). Fibroids are abnormal growths found in or near the uterus of women. These tumours can develop into large ones, causing severe abdominal pain and heavy periods. In some cases, they cause no noticeable signs or symptoms. The developments are non-cancerous or benign. The aetiology of fibroids is still unidentified. The actual source of uterine fibroids is unknown. However, experts have believed that variables such as genetic abnormalities or estrogen and progesterone hormone fluctuations may have a role.
Uterine fibroids come in a variety of sizes and shapes. Hormones have a prime role in the formation of uterine fibroids. For this reason, anti-hormone medicine can help reduce fibroids, but it is the only short-term treatment. Uterine fibroids, also known as leiomyomas, are benign muscular growths that have a low risk of turning cancerous.
Characteristics of Uterine Fibroids:
- Benign Tumors: They are not cancerous and rarely turn malignant.
- Variable in Size: They can be as small as a seed or grow as large as a grapefruit.
- Single or Multiple Growths: Some women develop only one, while others may have several.
- Hormone-Dependent: Oestrogen and progesterone influence their growth.
T
ypes of Uterine Fibroids:
- Intramural Fibroids: Develop within the uterus's muscular wall.
- Subserosal Fibroids: Form on the outer surface of the uterus.
- Submucosal Fibroids: Located beneath the uterine lining, often causing heavy bleeding.
- Pedunculated Fibroids: Attached to the uterus by a thin stalk, allowing movement.
Common Symptoms:
- Heavy menstrual bleeding (Menorrhagia)
- Pelvic pain or pressure
- Frequent urination (due to fibroid pressure on the bladder)
- Constipation or bloating
- Pain during intercourse
- Reproductive issues (infertility or complications in pregnancy)
Causes and Risk Factors:
- Hormonal Influence: Oestrogen and progesterone promote their growth.
- Genetic Factors: Family history increases the likelihood.
- Age: Most common in women aged 30–50.
- Ethnicity: More prevalent in African or Afro-Caribbean women.
- Obesity: Higher oestrogen levels contribute to fibroid growth.
Diagnosis and Treatment:
- Ultrasound, MRI, and Hysteroscopy detect fibroids.
- Treatment options include medications, myomectomy, uterine artery embolisation (UAE), or hysterectomy, depending on symptoms and fertility goals.
How do you prepare for a uterine myomectomy?
Preparing for a uterine myomectomy involves several steps to ensure a safe and successful procedure.
Here is a comprehensive checklist:
Pre-Procedure Preparation (Weeks or Months Before):
- Consult your doctor: Schedule an appointment with your gynaecologist or obstetrician to discuss the procedure and determine if a myomectomy is right for you.
- Imaging tests: Undergo imaging tests, such as ultrasound, MRI, or CT scans, to confirm the presence and size of fibroids.
- Blood tests: Get blood tests to check for anaemia, blood clotting disorders, and other conditions that may affect surgery.
- Stop hormonal medications: Discontinue any hormonal medicines, such as birth control pills, at least 2-4 weeks before surgery.
- Lose weight (if necessary): If you are overweight or obese, your doctor may recommend weight loss to reduce surgical risks.
Medical Preparation (Weeks or Months Before):
Your doctor may recommend medicine to reduce the size of your fibroids and make them easier to remove before surgery. Your doctor may prescribe gonadotropin-releasing hormone agonists, which block the production of estrogen and progesterone. These medications will induce temporary menopause. Once you stop taking these medications, your menstrual cycle will resume, and pregnancy should be possible.
Pre-Surgery Preparation (1-2 Weeks Before):
- Stop smoking: Quit smoking to reduce the risk of complications during and after surgery.
- Avoid aspirin and NSAIDs: Stop taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) to minimise bleeding risks.
- Arrange for post-operative care: Call a friend or family member to assist you during recovery.
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| The happy couple after myomectomy surgery |
Day Before Surgery:
- Fast and hydrate: Follow your doctor's instructions for fasting and hydration before surgery.
- Prepare your home: Clean and prepare your home for recovery, including setting up a comfortable resting area.
Day of Surgery:
- Arrive early: You must arrive at the hospital or surgical centre at the designated time.
- Bring necessary documents: Bring your insurance cards, identification, and any other required documents.
- Remove jewellery and contacts: Remove all jewellery, contacts, and makeup before surgery.
By following these steps, you will be well-prepared for your uterine myomectomy and set yourself up for a smooth recovery.
How Do Gynaecologic Surgeons Perform Myomectomy?
Preparation:
- Pre-operative tests: Blood tests, imaging studies (e.g., ultrasound, MRI), and other evaluations to assess overall health and confirm the presence of fibroids.
- Counselling: Experts discuss the procedure, potential risks and benefits, and alternative treatment options.
- Informed consent: The patient provides a written statement for the procedure.
Surgical Techniques:
Abdominal Myomectomy (Open Surgery)
- Incision: Experts provide a horizontal incision in the lower abdomen.
- Uterus exposure: The uterus is exposed and inspected.
- Fibroid removal: Surgeons remove the fibroids, and the uterine incision is closed.
Laparoscopic Myomectomy (Minimally Invasive)
- Small incisions: Drs make 3-4 small incisions in the abdomen.
- Laparoscope insertion: Surgeons insert a laparoscope (thin, lighted tube) through one incision.
- Fibroid removal: They use specialised instruments to remove the fibroids through the small incisions.
Robotic-Assisted Laparoscopic Myomectomy
- Small incisions: Similar to traditional laparoscopy.
- Robotic system: Surgeons use a robotic system to assist the surgeon during the procedure.
- Fibroid removal: The robotic system provides enhanced visualisation and precision fibroid removal.
Post-Operative Care:
- Pain management: Drs administer pain relief medication.
- Monitoring: They monitor vital signs and the surgical site.
- Recovery: The medical staff escorts the patient to the recovery room for observation and ongoing care.
Follow-Up:
- Post-operative check-ups: Follow-up appointments with the surgeon to monitor healing and remove sutures or stitches.
- Pain management: Ongoing pain management as needed.
- Fertility assessment: For women who wish to become pregnant, follow-up appointments to assess fertility.
A gynaecological surgeon uses robot techniques to operate surgical appliances remotely, skillfully manipulating the robotic arm. Your surgeon chops the fibroids into small pieces to extract them. If the fibroids are too large, the surgeon performs an abdominal myomectomy, making a larger incision in the abdomen. After the procedure, the surgeon removes the instruments, releases the gas, and closes the incisions. Following this procedure, the surgeon admits patients to the hospital for overnight observation.
Is Myomectomy Effective?
Yes, myomectomy is an effective treatment for uterine fibroids, especially for women who want to preserve their uterus and improve symptoms like heavy bleeding, pelvic pain, and infertility. However, its effectiveness depends on several factors, including fibroid size, number, location, and surgical method. Myomectomy is highly effective for symptom relief and fertility improvement but may not prevent fibroid recurrence. Regular follow-ups and lifestyle changes (balanced diet, weight management, and hormone regulation) help reduce the risk of regrowth.
Conclusion
Myomectomy is a lifeline for women seeking relief from uterine fibroids while preserving their fertility and overall well-being. Whether performed through open surgery, laparoscopy, or hysteroscopy, this procedure offers renewed hope by alleviating pain, heavy bleeding, and reproductive challenges.
While fibroid recurrence is possible, myomectomy remains one of the most effective uterus-sparing treatments available. With proper medical guidance, a healthy lifestyle, and regular follow-ups, women can regain their quality of life and embrace a future free from fibroid-related discomfort.
For those wishing to start a family or live without the burden of fibroid symptoms, myomectomy is not just a surgery—it is a path to healing and new possibilities.