Myomectomy

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Myomectomy

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Myomectomy is the surgical method to remove fibroids from the uterus. Fibroids are not cancerous; however, they require surgical treatment. Learn more about various types of myomectomies and your experience before, during, and after surgery.

 

Myomectomy

Myomectomy is the surgical method to remove fibroids from the uterus. Fibroids are not cancerous; however, they require surgical treatment. Learn more about various types of myomectomies and your experience before, during, and after surgery.

 

Benefits of Myomectomy procedure

  1. Myomectomy removes your fibroids and can relieve bleeding and other symptoms.
  2. Women who undergo myomectomy report improvement in fibroid symptoms, including decreased heavy menstrual bleeding and pelvic pressure.

Who needs Myomectomy?

  1. At times, cells from the inner surfaces of the uterus grow and develop into fibroids.[2,3] Myomectomy is a surgical procedure to remove fibroids from the uterus. Most fibroids are smaller in size and do not cause any symptoms. Thus, they do not require any treatment except regular observation by the gynaecologist.[4] However, large fibroids can have varied symptoms, requiring myomectomy. The symptoms of large fibroids include:
  2. Difficulty in getting pregnant: If you have a fibroid that has changed the uterus walls and can cause infertility, a myomectomy is done to improve the chances of pregnancy before in-vitro fertilisation.
  3. Myomectomy is a procedure that enhances the chances of having a baby. It removes a certain kind of fibroid called submucosal fibroid (growths located under the mucosal layer). Myomectomy preserves the uterus and only extracts the fibroids.
  4. Excessive painful bleeding during your periods
  5. Frequent urination can happen when a fibroid puts pressure on your uterus
  6. Bleeding between the periods
  7. Lower back pain and constipation, along with other symptoms
  8. The inability to empty the bladder completely, a feeling of fullness in the lower abdomen
  9. Your abdomen is distended, making you look pregnant
  10. The formation of uterine fibroids is usually due to a hormone called oestrogen, which causes the rapid multiplication of cells. You can be at a higher risk for developing fibroids if you are nearing menopause because of prolonged exposure to this hormone.
  11. It can also happen that symptoms of these fibroids either stabilise or go away when you’ve gone through menopause. This occurs because oestrogen levels decline in your body after menopause.

 

You should seek a gynaecologist if you observe the following symptoms of uterine fibroids:

  1. Pelvic pain
  2. Pregnancy problems
  3. Frequent urination
  4. Heavy and extended bleeding during your periods
  5. Constipation
  6. Bloating[3]
  7. Dysmenorrhea (painful menstrual periods, accompanied by uterine contractions)
  8. Menorrhagia (abnormally lengthy periods)
  9. Metrorrhagia (uterine bleeding at irregular intervals)
  10. Abnormal uterine bleeding[8]
  11. Dyspareunia (pain during sexual intercourse)
  12. If you have minor signs and symptoms, your gynaecologist may recommend other treatments, such as hormone therapy or pain medicines.[3] A myomectomy will only remove the fibroids, and the uterus will be left in place. This reason makes it an appropriate option for women who want to have a baby.

 

Myomectomy Procedure

Procedure Description

There are two ways in which a myomectomy can be performed:

Open myomectomy: 

  1. It is also called an abdominal myomectomy
  2. The procedure is selected for extremely large fibroids
  3. An incision will be made in your abdominal region. The incision can go across the bikini cut, or it can go up and down.[14]
  4. The uterine fibroids will then be removed from the walls of the uterus.
  5. The uterine muscle will then be sewn back together using several layers of stitches.

Minimally invasive myomectomy:

  1. There are many types of minimally invasive options for a myomectomy. The surgery usually has faster recovery rates.
  2. Standard laparoscopic myomectomy: 
  3. In this surgery, several minor cuts will be made in the abdomen to place instruments needed to move fibroids.
  4. One of those instruments is a small telescope that is inserted through the belly button.
  5. The fibroids will then be removed through small incisions or sometimes through the vagina.
  6. The surgeon may opt to get the aid of a robot, to finely control the movements of instruments in this type of surgery.

Single port myomectomy:

  1. Unlike laparoscopic myomectomy, this procedure will use only one opening near the belly button for all the instruments.
  2. This results in a slightly larger incision or a scar after the surgery, but there are no other incisions on the abdominal wall.

Hysteroscopic myomectomy: 

  1. No incision will be made in this type of surgery.
  2. When the fibroids are in the right place inside the uterus, the surgeon will place a specialised camera through the vagina.
  3. This camera has an attachment to remove the fibroids directly from the vagina.
  4. For all the surgeries, when the procedure is completed, the instruments will be removed. If there are any incisions, they will be closed and bandaged.

What to Ask and Tell the Doctor?

  1. While you are with your gynaecologist discussing treatment approaches for your condition, you can ask the following questions:
  2. Why do I need surgery?
  3. What surgical procedure do you recommend for my condition?
  4. How will I benefit from the surgery?
  5. What possible risks or complications can occur due to surgery?
  6. What would happen if I chose not to undergo surgery?
  7. How will the recovery process be?[16]
  8. It is also essential that your gynaecologist knows a few details about you to undergo your surgery smoothly. Therefore, during the appointment, you should inform your gynaecologist if you are:
  9. Currently using any prescription, non-prescription, or herbal medications[17,18]
  10. Having any health condition (e.g., pregnancy, diabetes, high blood pressure, breathing problems, heart problems, etc.)
  11. Having allergies to foods and medications[18]
  12. Smoking habits [17]

 

What to Expect Before Surgery?

  1. Before the surgery, your gynaecologist will choose the appropriate treatment depending on:
  2. Your signs and symptoms
  3. The position, size, and the number of fibroids present in the uterus
  4. Your future desires, if you want to get pregnant in the future or preserve your uterus for any other reasons[4]
  5. If your gynaecologist chooses myomectomy, the type of myomectomy to be performed will depend on factors, like:

                  Fibroid size

                  The number of fibroids

                  The experience of the surgeon

                  The position of fibroids in the uterus

6)Before the surgery, your surgeon will ask for several diagnostic tests to determine the fibroids’ size, location, and number. These tests include:

7)Physical test: The gynaecologist can feel the fibroids during a regular pelvic exam. Other tests need to be done to confirm and determine the exact location.

8)Ultrasonography: This procedure creates a picture of your internal organs using sound waves. Depending on the uterus size, the ultrasound is carried out via transvaginal (through the vagina) or transabdominal (through the abdomen) approach.

9)Magnetic resonance imaging (MRI): This procedure uses magnets and radio waves to create detailed images of your internal organs.

10)Computed tomography (CT): X-ray images are taken through a CT scan through various angles.

11)Hysteroscopy: A hysteroscopy uses a device called a scope to look at fibroids inside the uterus. This device has a thin, long tube with a tiny camera attached to it. A scope passes through your vagina and cervix and then moves into your uterus to take pictures.

12)Hysterosalpingography (HSG): A contrast material is initially injected inside the uterus, and then detailed X-rays of the uterus are taken.

13)Sonohysterography: This procedure provides more precise images than a standard ultrasound. This is an imaging test, and a catheter is placed transvaginally. Saline is inserted through that catheter. The extra fluid from the saline helps to create a clearer image.[4]

14)Blood tests: Blood tests are done to check for any anaemic condition and rule out any kidney infection.

 

What to Expect During Surgery?

  1. You will be positioned in the 10-degree reverse Trendelenburg position, as shown in the figure below.
  2. A bandage will be applied to the incisions after the surgery is completed.

Recovery and Post op care after the Myomectomy procedure

What to Expect After Surgery?

At Hospital:

  1. The nurse will note if there is any vaginal discharge.
  2. You may have some tubes at the surgical site to drain off excess fluid if necessary.
  3. Your catheter to drain off urine will be removed the following day or so.
  4. You should perform your breathing, coughing and leg exercises hourly.[20] 
  5. You may get to go home that same day or need to stay overnight in the hospital. Then, when you’re ready to go home, you’ll need to have someone to drive you home.

At Home:

  1. The hospital will provide you with essential pain medicines for your post-operative pain.
  2. You should resume a regular diet as soon as you can.
  3. To prevent the development of blood clots, moving around is recommended by gynaecologists.[3]
  4. Recovery time for an open myomectomy will be up to six weeks at home. The recovery period is two to four weeks for minimally invasive procedures like laparoscopic myomectomy. However, recovery is just a matter of days if the surgery is done hysteroscopically (through the vagina without incisions).[14]
  5. Depending on the type of procedure, you can return to work within two to six weeks (abdominal myomectomy takes the longest recovery time).
  6. After two weeks, you should aim to walk for about 10 minutes every day unless advised otherwise by your gynaecologist.[20]

 

First Follow-up Appointment

You will have a follow-up a few weeks after surgery. During the follow-up, your gynaecologist will remove stitches from the surgical site.

 

Risk and Complication of Procedure

When to See a Doctor?

See your gynaecologist right away if you observe the following symptoms:

  1. You cannot pass stools or gas.
  2. You are unable to drink fluids and have an abnormal feeling in the stomach.
  3. Your incision is not closed because of loose stitches.
  4. The bandage over your incision is soaked with bright red blood.
  5. You have signs of infection, such as:
  6. Increased swelling, warmth, pain, or redness
  7. Red stripes around the incision
  8. Discharge of pus from the incision
  9. A fever
  10. Excessive bleeding that soaks up more than one pad in an hour.
  11. Blood clots in your legs.
  12. Foul-smelling vaginal discharge.

 

Expert Doctors for Myomectomy

Dr. Surveen Ghumman Sindhu

Dr. Surveen Ghumman Sindhu

Infertility and IVF
35 years experience
98% Recommended
Dr. Surveen Ghumman Sindhu

Dr. Surveen Ghumman Sindhu

Infertility and IVF
35 years experience
98% Recommended
Dr. Surveen Ghumman Sindhu

Dr. Surveen Ghumman Sindhu

Infertility and IVF
35 years experience
98% Recommended
Dr. Surveen Ghumman Sindhu

Dr. Surveen Ghumman Sindhu

Infertility and IVF
35 years experience
98% Recommended
Dr. Surveen Ghumman Sindhu

Dr. Surveen Ghumman Sindhu

Infertility and IVF
35 years experience
98% Recommended
Dr. Tanya Buckshee Rohatgi

Dr. Tanya Buckshee Rohatgi

Infertility and IVF
24 years experience
97% Recommended
Dr. Tanya Buckshee Rohatgi

Dr. Tanya Buckshee Rohatgi

Infertility and IVF
24 years experience
97% Recommended
Dr. Tanya Buckshee Rohatgi

Dr. Tanya Buckshee Rohatgi

Infertility and IVF
24 years experience
97% Recommended
Dr. Tanya Buckshee Rohatgi

Dr. Tanya Buckshee Rohatgi

Infertility and IVF
24 years experience
97% Recommended

NABH Accredited Hospitals for Myomectomy

Apollo Cradle Maternity And Children's Hospital

Apollo Cradle Maternity And Children's Hospital

R-2 Near Nehru Place Flyover 110019
Excellence in Obstetrics and Gynaecology
4.5/5
Akanksha IVF Centre, Janakpuri

Akanksha IVF Centre, Janakpuri

A - 3/7 110058
Excellence in Obstetrics and Gynaecology
4.9/5
Apex Hospital, Naraina Vihar

Apex Hospital, Naraina Vihar

E-22, Goswami Girdhari Lal Marg 110028
Excellence in Obstetrics and Gynaecology
4.8/5
Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj

Fortis Flt Lt Rajan Dhall Hospital, Vasant Kunj

Aruna Asaf Ali Marg, Pocket 1 110070
Excellence in Obstetrics and Gynaecology
4.8/5
Alpine Hospital

Alpine Hospital

Plot No. 140, Near Mother Dairy 122001
Excellence in Obstetrics and Gynaecology
4.9/5
Max Super Speciality Hospital, Shalimar Bagh

Max Super Speciality Hospital, Shalimar Bagh

FC 50, Max Wali Rd, C And D Block 110088
Excellence in Obstetrics and Gynaecology
4.8/5
Avantika Multispeciality Hospital

Avantika Multispeciality Hospital

A3/8, 110085
Excellence in Obstetrics and Gynaecology
4.9/5
BH Salvas Hospital

BH Salvas Hospital

Chandan Palace 110043
Excellence in Obstetrics and Gynaecology
4.8/5
CDAS Super Speciality Hospital

CDAS Super Speciality Hospital

Malibu Town 122018
Excellence in Obstetrics and Gynaecology
4.5/5

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