Myomectomy is surgical removal of uterine fibroids. The goal is to bring back the uterus to its usual level of functioning. It is the only surgical procedure for uterine fibroids that can preserve the possibility of getting pregnant. There are cases of women that got through pregnancy without any problems after having this kind of surgery.
Besides abdominal, there are also laparoscopic and hysteroscopic myomectomy. Abdominal myomectomy represents the most classical approach:
| • | the surgeon makes an incision on the skin over the uterus, |
| • | takes the uterus out, then |
| • | makes another incision on the uterus itself, |
| • | finds the fibroids and cuts them out, then |
| • | reconstructs the uterus by suturing the walls with a dissolving suture, |
| • | and then |
| • | the completely restored uterus is brought back into the body. |
Abdominal myomectomy is a very flexible approach, because the surgeon can see and reach all parts of the uterus. If there are smaller fibroids that were not diagnosed earlier, they can be removed now too, and there is no limit as to the number of the removed fibroids. The whole procedure is done in a hospital setting, in deep anesthesia, and most patients can go home after two or three days. It should take them several weeks to get back to normal life, but this will vary from one woman to another. In any case, we are talking serious surgery here, so serious that not many surgeons dare do it at all.
Problems With Abdominal Myomectomy
The main problem is loss of blood. Large fibroids mean large basis through which the fibroid is held to the endometrium, the uterine interior wall. Cutting them out naively, with the usual surgical instruments, can produce large loss of blood, after which this entire method became infamous. It is of utmost importance to select a surgeon that does abdominal myomectomy often and with good results. Just to name two of many surgical techniques that reduce blood flow, a skilled surgeon in will inject medicines into the uterus that shrink blood vessels before the incision, and will use laser to incise the uterus as this also seals blood vessels and further reduces bleeding.
Abdominal Myomectomy vs. Other Forms of Myomectomy
If fibroids are on the inside of the uterus (submuocus), a resectoscope may be used, requring no incision at all. For fibroids on the outside of the uterus (subserous), or if there are fibroids on a stalk (“hanging” outside of the uterus but still attached to it — so called pedunculated fibroids), laparoscopy may be the method of choice; it will require several small incisions, but the recovery time afterwards is relatively short. Finally, abdominal myomectomy is for everything else, such as lots of fibroids or fibroids deep in the tissue of the uterus.