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December 10, 2017  
EDUCATION CENTER: Uterine Procedures
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  • Myomectomy

    Overview
    Reviewed by Jonathan Smith, MD

    Myomectomy is the name of the surgical procedure done to remove uterine fibroids (noncancerous tumors in the inner or outer uterine lining). Many women develop uterine fibroids late in their reproductive years and preceding menopause, and for a majority of these women, they are harmless and often go completely unnoticed. But some women experience pain or other complications as a result of uterine fibroids, especially when fibroids are large or there are many of them. The pain and complications associated with certain uterine fibroids can include dyspareunia (pain during sexual intercourse), digestive problems or urinary problems due to pressure on the digestive or urinary tract, abdominal pain and bloating or swelling, back pain, and menorrhagia (irregular or heavy menstrual bleeding). These symptoms may warrant treatment of the fibroids with surgery or other means.

    Detailed Description
    Myomectomy can be performed in a number of different ways, depending on the size, number, and location of the fibroids. In a laparotomy (or open abdominal surgery), doctors give the patient anesthesia, then cut into the abdomen and then the uterus, carefully removing the fibroid while preserving the nearby tissue. After the fibroid is cut out of the uterus, the incision in the uterus is reconstructed and sewn back together, and the abdomen is closed.

    In another approach, a laparoscopy, the surgeon inserts a telescope-like instrument called a laparoscope through a tiny incision in the abdomen, and other instruments through other incisions in the abdomen, and uses the laparoscope to guide removal of the fibroid without open surgery. A similar approach involves inserting a hysteroscope, another telescope-like instrument designed for exploring the uterus, through the cervix.

    Myomectomy, particularly myomectomy done by way of laparotomy, is a far more invasive procedure and has a longer recovery time than alternatives like myolysis or uterine fibroid embolization. The advantage to this procedure, however, is that it is currently the only one of these uterine fibroid treatments that generally makes it possible for women to preserve their fertility in some cases. This benefit is associated with myomectomy for several reasons. First, doctors are able to carefully repair the uterus at the site of fibroid removal, while with the other two methods, the body is left to deal with dead or dying tissue, sometimes with unpredictable results, such as scar tissue growth or infection at the site of the necrotic (dead) tissue. Also, the other treatments may affect the ovaries or other parts of the reproductive tract, due to decreased blood flow, the effects of radiation or injected materials, and even the possibility of uterine rupture in the case of pregnancy after myolysis.

    Patients are typically kept in the hospital for one to three days following laparoscopic or hysteroscopic myomectomy, and for three to five days following a myomectomy that requires laparotomy, due to the larger abdominal incision. After release from the hospital, patients may experience pain in the area of the incision or fibroid, vaginal bleeding, cramping, and in rarer cases, complications such as infection or abnormal clotting at the surgery site. Patients are usually given pain medications ranging from over the counter medications like Advil or Tylenol to stronger prescription pain killers. Patients are told to refrain from any strenuous physical activity or heavy lifting, which could strain the uterus, abdominal muscles, and other tissue that was cut into during the surgery, until the recovery period is over. The recovery period typically lasts for seven to ten days in the case of laparoscopic or hysteroscopic myomectomy, and up to eight weeks in the case of laparotomy. After this period of time, patients can return to normal activity, once advised to do so by their physician.

    Last updated: 06-Jun-07

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