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Myomectomy

A myomectomy is a minimally invasive procedure used to remove uterine fibroids. Unlike a hysterectomy, a myomectomy leaves the healthy parts of the uterus intact and may preserve your ability to get pregnant. It is the most frequently recommended surgical treatment for uterine fibroids.

There are different ways to perform a myomectomy. The procedure usually takes between one and two hours to complete. Your doctor will work with you to decide which procedure is best for you depending on the size and location of the fibroids. The three kinds of myomectomy are:

  • Hysteroscopy. A hysteroscopy removes uterine fibroids through the vagina. Surgeons usually use this procedure to remove smaller fibroids from inside the uterus. The surgeon uses a long, thin telescope with a light and camera at the end called a hysteroscope. The hysteroscope is inserted through the vagina and cervix and into the uterus. The surgeon injects a fluid into the uterus to make it easier to see the fibroids. He or she then uses a small tool to remove the fibroids.
  • Laparoscopy. A laparoscopy uses a long, thin telescope to see inside the pelvic area. Surgeons use this procedure to remove fibroids from outside the uterus. The surgeon makes a small incision in the abdomen to insert the laparoscope and a second incision to insert the surgical tool that removes the fibroids. Small incisions are also made in the uterus to gain access to the fibroids.
  • Laparotomy. Also called an abdominal myomectomy, a laparotomy involves removing uterine fibroids directly through an incision in the abdomen. Surgeons use this procedure to remove all types of fibroids no matter their size or location. The surgeon makes a horizontal incision at the bikini line or a vertical incision between the navel and the pubic bone. Incisions are then made in the uterus to remove each fibroid.

In some cases, surgeons may combine myomectomy techniques, such as performing a laparoscopy along with a minilaparotomy or using hysteroscopy and laparoscopy to remove fibroids attached to the outer and inner walls of the uterus.

Studies show that myomectomy relieves fibroid symptoms in 80 to 90 percent of patients. While the original fibroids do not regrow after surgery, new fibroids may appear. If this occurs, more invasive treatments may be necessary.

Although myomectomy is a minimally invasive procedure, it can become as invasive as a hysterectomy with a lengthy recovery time. The biggest risk with a myomectomy is blood loss. Other risks of the procedure include infection and an adverse reaction to anesthesia.

How We Can Help

How We Can Help

Myomectomy Treatment Information

What to Expect

Your doctor will order blood and imaging tests before the myomectomy to determine the size and location of the uterine fibroids and to make sure you are healthy enough for surgery. You may also take medicines or hormone treatments to shrink the fibroids before surgery. Some doctors prescribe leuprolide (Lupron) two to six months before surgery. The benefits of leuprolide include:

Be sure to tell your doctor about all the medicines you take before surgery, including any over-the-counter medicines and supplements. Your doctor may ask you to stop taking certain medicines before surgery.

Be sure to ask your doctor about the type of anesthesia you will receive during surgery. Your surgery team may use:

Follow your doctor's instructions the night before surgery. Typically, you will need to:

You should expect to stay in the hospital overnight or up to three days depending on the type of myomectomy performed. A laparotomy (abdominal myomectomy) usually requires a stay of two to three days. Laparoscopic and hysteroscopic myomectomies require an overnight hospital stay. Some hysteroscopic myomectomies do not require an overnight stay.

Procedure

Be sure to arrive at the hospital on time on the day of your surgery.

After surgery, you will be moved to a recovery room where a nurse will monitor your vital signs as you wake up. You will be given pain medicine to help you feel better. The surgeon will encourage you to get out of bed and move around as soon as possible to speed recovery and prevent blood clots in your legs.

Depending on the type of myomectomy, you will spend one, two or three nights in the hospital. You usually need two to three days to recover after an abdominal myomectomy.

Results

The removal of uterine fibroids usually stops heavy menstrual bleeding and pelvic pain and pressure. New fibroids may appear, and they may or may not require treatment. If you only had one fibroid removed, you have a lower risk of needing treatment for any new fibroids.

Most women who have a myomectomy are able to become pregnant. However, you should wait three months after the procedure before trying to become pregnant. In some cases, the baby may need to be delivered by cesarean section if the uterine wall is weak.

Recovery Time

You should expect some vaginal spotting for up to six weeks depending on the type of myomectomy performed.

It will take four to six weeks for you to fully recover and return to normal activities after an abdominal myomectomy.

The recovery time is shorter (between one and three weeks) for a laparoscopic or hysteroscopic myomectomy.

Physician Follow-Up

You will see your surgeon for a follow-up visit two to six weeks after the myomectomy. He or she will monitor your recovery and check for any new fibroids.

Your doctor usually performs a pelvic exam three months, six months and one year after the myomectomy to check for fibroids. An ultrasound may also be performed to check for any fibroid recurrence.

If no new fibroids are found after one year, your doctor will likely recommend annual exams.


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