Myomectomy for Uterine Fibroid Removal
Myomectomy at a glance
What is myomectomy?
Myomectomy is surgery that removes uterine fibroids, which are noncancerous tumors that have developed in the uterus. It is often recommended for the removal of uterine fibroids in cases where they are causing heavy menstrual bleeding, pelvic pain or they are a suspected cause of infertility.
The size and location of the fibroids in the uterus are factors in determining whether myomectomy is the correct option. The procedure involves general anesthesia and is performed in an outpatient surgical facility or in a hospital. The methods for performing myomectomy are hysteroscopy, laparoscopy and laparotomy. The method the surgeon uses depends on the placement and size of the fibroids.
Uterine fibroids and infertility
Fibroids are found in 20 percent of women of reproductive age. Fibroids may be responsible for infertility or spontaneous miscarriages. It’s estimated that about 5 percent of infertile women have fibroids. Their size and location determine whether fibroids affect fertility or cause miscarriages.
Fibroids that grow inside the uterine cavity or distort its lining (submucosal) interfere with the blood flow within the uterus. This can decrease the ability of the embryo to stick or implant in the uterine lining to develop into a pregnancy. The submucosal type of uterine fibroid is often associated with impaired fertility as well as heavy menstrual bleeding.
Very large fibroids (> 4 cm in diameter) growing in the uterine muscle (intramural) can have the same effect and can keep the uterus from expanding adequately during pregnancy. These can also block the fallopian tubes or distort the cervix, limiting the chances of pregnancy.
Advantages of myomectomy in treating fibroids
Regardless of the type of myomectomy procedure performed, the procedure can remove fibroids from uterine tissue while sparing the woman’s ability to have children in the future. In fact, after myomectomy is performed to treat infertility, there is often a sharp increase in conception – about 50 percent of women become pregnant within six months after surgery.
The goal of myomectomy is to remove fibroids that are causing symptoms and to reconstruct the uterus back to its optimal condition. Myomectomy can get rid of these issues, oftentimes more efficiently than other treatments, such as medications and the embolization procedure that seeks to starve the fibroid but carries a risk of infertility.
Uterine fibroids are a common indication for a hysterectomy, which is the complete removal of the uterus and sometimes other female reproductive organs. Hysterectomy to treat fibroids renders a woman infertile; myomectomy to remove fibroids does not. Women who may not wish to get pregnant in the future often still prefer to keep their uterus intact, making myomectomy a good option for them.
Women are eligible for this type of myomectomy when they have a few submucosal fibroids (fibroids that bulge into the uterus or sit on the inner surface of the uterine cavity). During hysteroscopic myomectomy the surgeon will use a hysteroscope, a small flexible instrument with a camera on one end allowing the doctor to visualize the surgery, inserted through the cervix to access the uterus.
The surgeon then uses tools attached to the hysteroscope to cut away small slices of the fibroid until it has been removed. This process is known as morcellation.
If a woman has a small number of subserous fibroids, or fibroids that bulge out away from the inside of the uterus, a surgeon may recommend fibroid removal via laparoscopy. In a laparoscopic myomectomy a surgeon will make small incisions in the “bikini line” or near the belly button so that a thin instrument fitted with a camera and surgical tools can be inserted.
Robotic myomectomy is performed similarly using four small incisions and a robotic surgical system with robot arms controlled by the surgeon to carefully cut the fibroid into smaller pieces to remove.
Abdominal myomectomy (via laparotomy)
Fibroid removal performed via laparotomy, often referred to as abdominal myomectomy, is employed if fibroids are large, numerous or deeply embedded in the uterine tissue. Laparotomy also uses one horizontal incision in the bikini line or vertical incision below the bellybutton to access fibroids. Laparotomy incisions are larger than those needed for laparoscopy, but they allow for greater access and ease in removing fibroids from the uterus.
When the best course of treatment for uterine fibroids is a myomectomy, we perform the surgery through the smallest possible incision, mini-laparotomy. For women experiencing infertility due to fibroids, this allows for a prompt restoration of female fertility.
Recovering from myomectomy
The amount of time needed to recover after the procedure depends on the type of procedure. Recovery times for each method are as follows.
- Hysteroscopic myomectomy is an outpatient procedure. It may involve several hours of observation post procedure. Normal activity can be resumed the next day.
- Laparoscopic myomectomy is also an outpatient procedure. It rarely involves an overnight hospital stay. It may require a 1-week recovery period before returning to normal activities.
- Abdominal myomectomy is often performed as an outpatient procedure. It may involve a short hospital stay if the fibroids are large. A 2- to 3-week recovery period is usually needed before returning to normal activities.
Recovery times are approximate. It’s important to avoid strenuous activities and heavy lifting until after surgical incisions have healed completely. It’s advisable for a woman to avoid sexual intercourse until the surgeon has cleared her to do so.
Risks of myomectomy fibroid removal
Myomectomy has a low complication rate, however, it does pose some risks. Risks include the following.
Infection is a potential risk of all surgical procedures. Approximately 5 percent of women develop an infection after surgery, but this can be treated with antibiotics.
Excessive blood loss can occur in women in 10 percent of patients, requiring transfusion and a few days of hospitalization.
Scar tissue can develop outside of the uterus and attach to nearby structures such as the intestine or fallopian tubes.
Fibroid recurrence is an additional risk. There is no guarantee that removing fibroids surgically will keep new fibroids from developing in the uterus.
Pregnancy and childbirth complications can occur as the result of fibroids themselves and from the myomectomy. In cases where a woman has received a myomectomy previously, a doctor may recommend cesarean (C-section) delivery to prevent delivery complications such as uterine rupture.
Other very rare complications include the potential spread of cancer, if it is present, after morcellation, which is the process of cutting the fibroid into smaller pieces to remove it. In rare instances a cancerous tumor is mistaken for a noncancerous fibroid and the cancer is spread unknowingly. The risk of spreading cancer is lower when the procedure is performed via laparotomy.
Affordable myomectomy at Servy Institute for Reproductive Endocrinology
We strive to make infertility treatment affordable by offering exceptional surgical expertise at a competitive price. Outpatient myomectomy is performed at the Augusta Surgical Center (surgeon is Dr. Edouard Servy) for a total cost of $6,500, which is half the normal cost at a hospital. The cost includes fees for the surgeon, anesthesia and outpatient hospital facility.