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Gynaecology
A myomectomy is a surgical procedure performed to remove uterine fibroids, also known as leiomyomas. These are benign growths that commonly develop in the uterus during one’s childbearing years. However, they can be discovered at any stage of life. The key advantage of a myomectomy is that it removes the fibroids while leaving the uterus intact. This makes it the preferred option for women who wish to preserve their future fertility.
A myomectomy is generally recommended when fibroids are severely affecting a woman's quality of life with heavy menstrual bleeding, pelvic pain, frequent urination and fertility issues. The decision to proceed with a myomectomy is made after a detailed consultation with the patient taking into consideration the size and location of the fibroids, symptoms, and reproductive plans.
There are several ways in which a myomectomy can be performed, depending on the severity of one’s condition, the patient’s preferences, and the gynaecologist’s expertise. These techniques include:
In a laparotomy, the gynaecologist makes an incision in the abdomen to access and remove the fibroids. This method is suitable for complex cases with larger or multiple fibroids in hard-to-reach locations. The recovery time is typically longer with this method and involves a short hospital stay for observation. However, with adequate analgesia, the discomfort can be minimized.
This minimally invasive procedure involves one or several small incisions in the abdomen. A tiny camera (laparoscope) is inserted into one of the incisions, allowing the gynaecologist to utilize the surgical instruments to remove the fibroids. It generally results in less pain and a faster recovery compared to a laparotomy.
Transcervical myomectomy avoids abdominal incisions. Instead, the gynaecologist accesses and removes submucosal fibroids (located within the inner lining of the uterus) with an operative hysteroscope inserted via the vagina and cervix. This procedure often has the shortest recovery time. This outpatient procedure does not leave any scars and recovery typically takes just a few days.
This procedure uses a robot-assisted surgical set-up to facilitate the removal of fibroids. This combines the advantages of minimally invasive surgery with enhanced precision and control but is the most expensive method.
As with all surgical procedures, myomectomies come with certain risks and possible complications; though these are rare in the hands of an experienced gynaecologist and can be safely managed by a well-trained medical team.
Possible risks and complications include: infection, bleeding, damage to surrounding organs, scar tissue formation (adhesions), deep vein thrombosis and fibroid recurrence. Be sure to discuss the potential risks and benefits with your gynaecologist before deciding to proceed with the operation.
Recovery time after a myomectomy varies based on the type of procedure performed. Minimally invasive procedures like laparoscopic, hysteroscopic or robotic myomectomy typically have shorter recovery times ranging from two to four weeks, compared to a laparotomy which may take up to four weeks.
Following surgery, it is common to experience some pain and discomfort. Rest assured that this can be managed with the adequate analgesics prescribed. You should also follow your gynaecologist’s post-operative care instructions to ensure a smooth recovery.
A hysterectomy involves the removal of the entire uterus (and sometimes, other surrounding structures as well). On the other hand, a myomectomy only removes the fibroids while preserving the uterus.
Not all fibroids need to be surgically removed, particularly small fibroids that do not cause symptoms. However, if your fibroids are symptomatic or are causing complications, they will need to be removed to prevent the symptoms from worsening.
Unfortunately, it is possible for fibroids to recur after a myomectomy. However, the risk of recurrence varies from person to person.
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