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MYOMECTOMY
What is myomectomy?
Myomectomy is a surgical procedure that removes uterine fibroids – non-cancerous tumors that can originate from the muscle and connective tissue of the uterus. About 20-40% of women will be diagnosed with uterine fibroids in their lifetimes, but only a fraction of those will require treatment. In some cases, uterine fibroids can cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. They can also interfere with fertility and pregnancy. (Click here for more information on uterine fibroids and treatments.)
Will my myomectomy impair my ability to conceive?
Women have many options in the management of uterine fibroids. Since myomectomy leaves the uterus intact, this procedure is the preferred fibroid treatment for women who want to become pregnant.
How is myomectomy performed?
A myomectomy can be performed in several ways, often depending on the location, size and number of uterine fibroids. Large uterine fibroids may be removed via a full abdominal incision (also called “open” surgery). Recovery after this kind of surgery usually takes four to six weeks.
In most cases, myomectomy can be perfomed using laparoscopy [link here] – a minimally invasive surgical procedure involving small cuts in the abdominal wall. With this approach, special tools are used to break apart and remove the uterine fibroids through the surgical openings. Compared to open surgery, laparoscopy offers the following potential benefits:
- Significantly less pain
- Less blood loss
- Fewer complications
- Less scarring
- A shorter hospital stay
- A faster return to normal daily activities
One possible disadvantage of laparoscopy compared to open surgery is a lower level of access and visibility for the surgeon. However, another approach, called da Vinci Myomectomy, offers the advantages of laparascopy combined with improved surgical control and access. With the da Vinci Surgical System, small incisions are used to introduce miniaturized surgical instruments and a high-definition 3D camera. Operating from a da Vinci console a few feet away, Dr. Garofalo views a magnified, high-resolution 3D image of the surgical site. State-of-the-art computer technologies convert Dr. Garofalo’s hand movements into precise micro-movements of the da Vinci instruments.
Due to the increased risk of bleeding, a myomectomy is never performed during pregnancy.
What risks or disadvantages are associated with myomectomy?
When a laparoscopic or da Vinci approach fails to accomplish the surgical goal, a full abdominal incision may be made in order to allow traditional surgical access. Although this happens in only a small percentage of cases, everyone undergoing laparoscopic or da Vinci surgery should be prepared for this possibility.
If pregnancy occurs after any kind of myomectomy, a cesarean section may be needed for delivery. This depends in part on the size and location of the myomectomy incision and is less likely with a laparoscopic or da Vinci myomectomy than with an open surgery.
After myomectomy, uterine fibroids return in 10% to 50% of women. Talk to Dr. Garofalo about whether your type of fibroid is likely to grow back, and what your options could be if this occurs.
What is the recovery period following myomectomy?
Most patients are fully recovered and ready to return to full activity less than two weeks after extensive laparoscopic or da Vinci procedures. As a general rule, you should feel better every day after the procedure.
Can a myomectomy improve my fertility?
Uterine fibroids can interfere with fertility by blocking or compressing the Fallopian tubes. Fibroids may also obstruct blood flow to the uterine lining, making it more difficult for an implanted embryo to grow and develop. In these cases, myomectomy can remove the obstructions, improve fertility, and reduce the likelihood of fibroid-related miscarriages or birth defects.
Links to additional information