The permanent treatment for fibroids is their removal. Asymptomatic fibroids can be observed as long as they are not growing at a fast pace. To remove the fibroids there are two options either to remove the uterus along with the fibroids (hysterectomy) or just remove the fibroids and reconstruct the uteus for future use ( myomectomy).
A myomectomy is a procedure to remove fibroids, and then reconstruct the uterus to function normally and also improve fertility. There are few indications to perform myomectomy-
- Symptomatic Fibroids Ė Heavy Bleeding or pain during menstrual cycle
- Pressure symptoms due to size and location of fibroids
- Large mass in the abdomen
- Infertility due to fibroids
- Rapidly growing in size
- There may be a doubt of developing cancer in fibroid
Women who undergo myomectomy have improvement in symptoms, including heavy menstrual bleeding and pelvic pain. Fibroids that are responsible for infertility, in these women removal of fibroids increases the chance of spontaneous conception.
Tests before myomectomy
The Ultrasound of the pelvis is the initial test to diagnose fibroids. How ever before doing myomectomy, we prefer to do MRI test. The MRI evaluation helps to locate the number and size of fibroids and hence helps to plan the surgery. Apart from these tests one may require to check for status of anemia and all the other tests that are needed before any surgical intervention.
Surgical techniques for myomectomy
- Abdominal myomectomy- this is an open operation and is performed via a large abdominal incision. This surgery is almost not done in todays surgical practice as the recovery and blood loss is more. The post operative adhesions are also more. At our unit @ Apollo Hyderabad, we offer minimally invasive myomectomy no matter what the size or number of fibroids are present.
- Laparoscopic myomectomy- During this procedure, long straight surgical instruments are inserted through the small incisions. A laparoscope is used to provide view of the uterus and fibroids and seeing these images on a video monitor the surgery is preformed.
- Robotic assisted myomectomy- This procedure is similar to a traditional laparoscopy; however due to use of 3D high-definition vision and wristed instruments that bend and rotate much greater than the human wrist, surgery is done with better precision and control. This reduces blood loss and significantly improves the uterine reconstruction after the removal of the fibroids.
- Hysteroscopic myomectomy- If the fibroid is projecting into the cavity, it can removed by using a hysteroscope. This is inserted into the uterine cavity through the vagina and the fibroid is removed using electrocautery. This procedure does not involve any incision and is done as day care surgery has a short recovery period of 2-3 days before resumption of full activity.
- How often do you perform myomectomy?
- How often have myomectomy converted to hysterectomy in your experience?
- How often patients need blood transfusions?
- What is the expected length of stay in hospital?
The most critical part of myomectomy is uterine reconstruction of the uterus for adequte function both for menstrual bleeding as well as for future reproduction. The defects so created in the wall of uetrus should be repaired in multiple layers. Additionally one must take care to prevent post opertaive bleeding and infection. If this step is not done well, the uterus may rupture during a subsequent pregnancy or delivery. The repair done with the use of robotic instruments enables the surgeon to repair the uterus properly as well as minimises the blood loss. Surgeon performing the myomectomy should be able to assure the patient prior to surgery that the chance of intended myomectomy turning into a hysterectomy is minimal due to uncontrollable blood loss.
Ask your surgeon these questions before myomectomy
Was invited to operate at Raipur Medical College at the FOGSI North Zone Yuva Congress. Dr Rooma Sinha demonstrated urogynecological surgeries for the delegates and later also gave lecture on setting standards for caesarean Section.