Myomectomy for Uterine Fibroid Removal

Myomectomy at a glance

• Myomectomy is a fertility-sparing surgery used to remove uterine fibroids, also called leiomyomas, which are noncancerous tumors that develop in the uterus.
• Surgeons can perform a myomectomy via laparoscopy, hysteroscopy or laparotomy (open surgery) depending on the size, quantity and location of the fibroids.
• This procedure is often used to remove fibroids that are causing infertility or other severe symptoms such as pelvic pain or heavy menstrual bleeding.

What is myomectomy?

Myomectomy is a surgical treatment that removes fibroids from the uterus, without harming a patient’s ability to become pregnant later. This procedure is often used to remove uterine fibroids causing symptoms, such as heavy bleeding, pain or infertility.

Myomectomy can often treat fibroids more efficiently than other treatments, such as medications or uterine artery embolization, which carries a risk of insufficient treatment or infertility.

What are uterine fibroids?

Uterine fibroids are noncancerous tumors that develop in the uterus. Fibroids are extremely common and are often not harmful unless they are causing problems for a patient. There are several classifications of fibroids patients can experience.

Submucosal fibroids are those that grow within the uterine cavity or the tissue that lines the uterus, which is called the endometrium. These typically bulge into the uterine cavity.

Intramural fibroids grow within the muscular walls of the uterus.

Subserousal fibroids form on the outside of the uterus and grow into the pelvic cavity. These growths can become quite large and cause bulk symptoms.

Pedunculated fibroids are fibroids that are attached to the inside or outside of the uterus by a stalk.

The recommended treatment for fibroids depends on the patient’s age, the type of fibroids present, the severity of the patient’s symptoms and whether the patient plans to become pregnant. Women who are looking to become pregnant may receive different treatment recommendations and are often good candidates for myomectomy fibroid removal, depending on the type, size and number of fibroids.

Treating uterine fibroids with myomectomy

The size and location of uterine fibroids are determining factors in the type of myomectomy procedure the surgeon recommends. Regardless of the surgical method, myomectomy is unlikely to harm a woman’s ability to conceive children. However, certain types of myomectomies may affect the future mode of delivery of a baby and necessitate delivery before a patient’s due date. Fibroid removal surgery can be performed with a hysteroscopy, laparoscopy or laparotomy.

Hysteroscopic

Hysteroscopic myomectomy uses a small camera, known as a hysteroscope, which is inserted through the vagina and cervix to access the uterus. The camera on the hysteroscope allows the surgeon to view submucosal fibroids. The fibroid is removed from the inside of the uterus through a process in which a small tool attached to the hysteroscope cuts away small pieces of the fibroid. This is a good option for patients with submucosal fibroids.

Laparoscopic & robotic surgeries

Laparoscopic and robotic procedures employ small incisions in the abdomen and near the bellybutton to access fibroids growing on the outside of the uterus and into the pelvic cavity. Laparoscopy uses a small camera and surgical tools to remove fibroids. A robotic surgical system uses small robotic arms controlled by the surgeon to cut the fibroid into smaller pieces.

Laparotomy (abdominal laparotomy)

Laparotomy refers to an open surgical method that uses one horizontal incision in the bikini line or vertical incision below the bellybutton to access the pelvic cavity. This surgical approach is used in cases where fibroids have grown quite large, are deeply embedded in tissue, or a significant number of fibroids are present.

Who is a good candidate for the surgery?

The fertility sparing qualities of myomectomy make it an excellent option for women experiencing fibroid-related infertility or women seeking fibroid symptom relief who plan to become pregnant later in life.

In cases where less invasive methods used to treat fibroids are not effective, a doctor may recommend a surgical intervention like myomectomy.

Alternatives to myomectomy

Patients who are not looking to become pregnant in the near future might consider less invasive treatments. These include monitoring the size of a fibroid with regular doctor’s visits, or use of hormonal contraceptives or injections to reduce fibroid symptoms.

Embolization, another common treatment that uses injections to cut off a fibroid’s blood supply, has a higher potential of causing infertility and is often not recommended for women planning to have children.

Hysterectomy, the surgical removal of the uterus, is another potential treatment, though it does render patients unable to carry their own children. Hysterectomy is a good option for women who have completed childbearing.

Risks of fibroid removal surgery

One potential risk of this procedure is the chance for partially removed fibroids to grow back or new fibroids to develop after the procedure. Myomectomy is often not a permanent solution for severe symptoms.

The procedure itself has a low complication rate, but it does pose risks such as:

• Excessive blood loss with need for blood transfusion or hysterectomy.
• Development of scar tissue.
• Pregnancy or childbirth complications.

There is also a slight risk of spreading cancerous cells in rare cases. These are when cancerous tumors are mistaken for noncancerous fibroids and cut into small pieces for removal during the morcellation process. Generally, this is why many gynecologists no longer recommend intraabdominal morcellation.