Myomectomy is a surgical procedure advised in the case of uterine fibroids. The surgeon
removes fibroids from the uterine surface and preserves the uterus body parallelly.
Fibroid or leiomyoma is a non-cancerous or benign tumor of the female reproductive
organs. Its size can vary from as small as a pea to as large as a softball. A fibroid
can grow as an isolated mass or can be numerous.
According to the location, fibroids can be of three types:
- Intramural fibroids: They are the most common type of fibroids that grows within the
muscular uterine wall.
- Subserosal fibroids: They appear as a stalk-shaped mass outside the uterus.
- Submucosal fibroids: They occur inside the uterine lining (endometrium). The
submucosal fibroids appear as a bulge into the uterus cavity.
Myomectomy is a very effective surgical procedure, but chances of reappearance of
fibroids are very likely. A woman approaching menopause has fewer chances of
reappearance of fibroids after surgery than a younger-aged woman.
Indications Of Myomectomy
Although fibroids are benign, they can still cause many problems. Myomectomy procedures
have a higher success rate than the traditional surgical approach. Your clinician can
advise myomectomy in the following conditions:
- Heavy menstrual bleeding or menorrhagia in patients with myomas
- Pressure on surrounding organs such as ureters, bowel, and bladder
- Continuous pelvic pain and discomfort
- Difficulty in getting pregnant
- Recurrent pregnancy loss due to presence of fibroids
- Rapid enlarging fibroid
Indications Of Myomectomy
Although fibroids are benign, they can still cause many problems. Myomectomy procedures
have a higher success rate than the traditional surgical approach. Your clinician can
advise myomectomy in the following conditions:
- Heavy menstrual bleeding or menorrhagia in patients with myomas
- Pressure on surrounding organs such as ureters, bowel, and bladder
- Continuous pelvic pain and discomfort
- Difficulty in getting pregnant
- Recurrent pregnancy loss due to presence of fibroids
- Rapid enlarging fibroid
The patient feels relief from these bothersome symptoms immediately after surgery.
Types of Myomectomy Surgery
Depending on the size, number, and location of your fibroids, a myomectomy surgery can be
done by following different ways:
Abdominal myomectomy or open myomectomy
Abdominal myomectomy is major surgery. The surgeon recommends it in the case of
large fibroids that are usually greater than 6 to 7 cms in size.
This procedure involves opening the lower abdomen by the surgical incision. The
incision can be vertical or horizontal, depending on the size of fibroids.
Open myomectomy provides a wide area to assess the condition of surrounding organs
in case of large or multiple fibroids.
After open myomectomy, surgeons generally recommend a Caesarean section (C-section)
for the delivery of future pregnancies.
It is an open surgical procedure, so risks associated with surgery are the same as
other major surgery such as:
- Heavy blood
loss and need for blood transfusion
- Pain and limited movability
- Wound infection
- Hospital stay and recovery time is more
Hysteroscopic myomectomy
Hysteroscopic myomectomy indicated in submucosal fibroids with a size range of 2 to
3 cms. In hysteroscopic myomectomy, the surgeon removes fibroids through the vagina.
In hysteroscopic myomectomy, the surgeon inserts a resectoscope through the vagina.
A resectoscope is a tube with a lens for viewing the fibroids. A heated wire loop
removes the fibroids. Your surgeon can send tissue samples from fibroids to the
laboratory for biopsy examination.
Hysteroscopic myomectomy is an outpatient surgical procedure. It means you can go
home after a few hours if you feel normal.
You can experience some cramping and light bleeding after the procedure. Recovery
time is less compared to surgery.
Laparoscopic myomectomy
Your surgeon may advise laparoscopic surgery in fibroids less than 5 to 6 cms and
projected outside the uterus. If the lesion is more than 6 cm, open surgical
myomectomy is the procedure of choice.
The surgeon incises three to four small incisions (less than 1 cm) on the lower
abdominal wall. The surgeon inserts a laparoscope through one of the incisions that
helps the surgeon view fibroids and structures of the uterine cavity. Long surgical
instruments can be inserted from other incisions to remove the fibroids.
Although this procedure has many advantages, it does have some rare risks such as:
- Injuries to internal organs
- Uterine lining becomes weak
- Bleeding and wound infection
If you want to be pregnant in the future, your surgeon may suggest abdominal
myomectomy in place of laparoscopic myomectomy.
Myomectomy is a very effective treatment with minimal side effects. So, if your
doctor recommends a myomectomy, you can go for it without any hesitation.
Complications related to procedure:
The use of an aspirating needle to retrieve female eggs can cause complications like
- Bleeding
- Infection
- Damage to the bowel
- Damage to the bladder
- Damage to the blood vessel
Ectopic pregnancy:
It happens when implantation of the fertilized egg occurs outside the uterus, causing
the termination of pregnancy.
Stress:
IVF not only puts a financial burden, but it is also physically and psychologically
draining. A detailed discussion with the counselors and family before and during the
procedure can help you sail out through this stressful journey.
What you can expect:
IVF involves five steps
- Ovarian stimulation
- Egg retrieval
- Sperm retrieval
- Fertilization
- Embryo
transfer
One IVF cycle typically takes two to three weeks.
OI involves the use of synthetic hormones to stimulate the ovaries. The stimulated
hormones produce multiple eggs, rather than a single egg that typically develops during
the monthly cycle. Multiple eggs increase the chances of successful fertilization during
IVF.
Egg retrieval
Your fertility doctor will do the egg retrieval procedure approximately 35-36 hours
before ovulation.
During egg retrieval, the doctor will guide an ultrasound probe into your vagina and
identify follicles. The fertility expert then inserts a thin needle into an
ultrasound guide, reaches the vagina, then into the follicles, and retrieves the
eggs.
Sperm retrieval
The doctor takes a semen sample from the male partner on the morning of egg
retrieval.
Fertilization
Fertilization between eggs and sperms can happen in two ways:
Conventional insemination: It involves mixing and overnight incubation of sperm and
eggs.
Intracytoplasmic sperm injection (ICSI): In ICSI, a fertility expert injects a
single healthy sperm directly into each mature egg. Your doctor may recommend ICSI
when poor semen quality or sperm number leads to failure of previous IVF cycles.
Embryo transfer
The embryo transfer procedure is the final step of the IVF cycle. The success of IVF
depends on the precise placement of the embryos in the middle of the endometrial
cavity. The doctor should complete the procedure with minimal trauma of the
endometrium.
After the procedure
After the embryo transfer, you may feel some discomfort due to painful and swollen
ovaries. You can resume your daily activities as soon as you feel normal.
Results
Your doctor will do a blood test for pregnancy, typically 12 to 14 days after the
egg retrieval process.
If the result is positive, the doctor will refer you to an obstetrician for further
care.
If you’re not pregnant, you’ll likely get your period within 5 to 7 days after
stopping medications.
