Myomectomy

Myomectomy is the removal of fibroids (noncancerous tumors) from the wall of the uterus. Myomectomy is the preferred treatment for symptomatic fibroids in women who want to keep their uterus. Larger fibroids must be removed with an abdominal incision, but small fibroids can be taken out using laparoscopy or hysteroscopy.

Whe a Myomectomy is performed

A myomectomy can remove uterine fibroids that are causing symptoms. It is an alternative to surgical removal of the whole uterus (hysterectomy). The procedure can relieve fibroid-induced menstrual symptoms that have not responded to medication. Myomectomy also may be an effective treatment for infertility caused by the presence of fibroids.

How a Myomectomy is performed

Usually, fibroids are buried in the outer wall of the uterus and abdominal surgery is required. If they are on the inner wall of the uterus, uterine fibroids can be removed using hysteroscopy. If they are on a stalk (pedunculated) on the outer surface of the uterus, laparoscopy can be performed.

Removing fibroids through abdominal surgery is a more difficult and slightly more risky operation than a hysterectomy. This is because the uterus bleeds from the sites where the fibroids were, and it may be difficult or impossible to stop the bleeding. This surgery is usually performed under general anesthesia, although some patients may be given a spinal or epidural anesthesia.

The incision may be horizontal (the "bikini" incision) or a vertical incision from the navel downward. After separating the muscle layers underneath the skin, the surgeon makes an opening in the abdominal wall. Next, the surgeon makes an incision over each fibroid, grasping and pulling out each growth.

Every opening in the uterine wall is then stitched with sutures. The uterus must be meticulously repaired in order to eliminate potential sites of bleeding or infection. Then, the surgeon sutures the abdominal wall and muscle layers above it with absorbable stitches, and closes the skin with clips or nonabsorbable stitches.

When appropriate, a laparoscopic myomectomy may be performed. In this procedure, the surgeon removes fibroids with the help of a viewing tube (laparoscope) inserted into the pelvic cavity through an incision in the navel. The fibroids are removed through a tiny incision under the navel that is much smaller than the 4 or 5 inch opening required for a standard myomectomy.

If the fibroids are small and located on the inner surface of the uterus, they can be removed with a thin telescope-like device called a hysteroscope. The hysteroscope is inserted into the vagina through the cervix and into the uterus. This procedure does not require any abdominal incision, so hospitalization is shorter.