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MYOMECTOMY (Laparotomy)

WHAT IS A MYOMECTOMY?

Myomectomy or Uterine Myomectomy is sometimes called a Fibroidectomy.

The procedure refers to the surgical removal of:

uterine leiomyomas, also known as Fibroids.
benign or non-cancerous growths on the uterus

In contrast to a Hysterectomy, the uterus remains preserved and the woman retains her reproductive potential.

Outcomes (eg: success rates)

WHAT CONDITIONS DOES A MYOMECTOMY HELP?

A myomectomy is an operation performed to remove benign tumours called Fibroids from the muscular wall of the uterus.

Myomectomy is the treatment of choice for women with fibroids who desire fertility.

WHY IS A MYOMECTOMY REQUIRED?

Patients have many options in the management of uterine Fibroids, including

observation,
medical therapy (such a GnRH agonists),
hysterectomy,
uterine artery embolization, and
high-intensity focused ultrasound ablation.

Despite these many options, the surgical approach of selected Fibroid removal remains an important choice for those women who want or need to preserve the uterus.

WHO IS A MYOMECTOMY SUITABLE FOR?

The presence of a Fibroid does not mean that it needs to be removed. Many women with uterine fibroids do not experience any symptoms.

The Fibroids needed to be removed are:

typically large in size, or
growing at certain locations such as bulging into the endometrial cavity causing significant cavity distortion.

Removal maybe necessary when a patient experience symptoms including:

Abnormal or heavy and prolonged menstrual bleeding,
bleeding between periods,
pelvic pain or pelvic pressure
infertility,
lower back pain,
pain during intercourse and
urinary or bowel problems.

Rarely may you have difficulty emptying your bladder, difficulty moving your bowels, anaemia due to heavy menstrual bleeding.

TYPES OF MYOMECTOMY

The type of Myomectomy depends on the size and site of the fibroid. There are several types of Myomectomy, these include:

Open Multiple Myomectomy

Called Myomectomy is the removal of 4 or more Fibroids followed by reconstruction of the uterus. This is performed as an open (laparotomy) procedure. The open approach is often preferred for larger lesions.

Also suitable when the fibroid is in the uterine body or outside the muscle layer, then it will need to be removed through the abdomen, either laparoscopically with a long thin camera through small incisions on the abdomen or an open operation (laparotomy) through a long incision on the abdomen.

Laparoscopic Myomectomy

Also called Myosure is the removal of Fibroid in the muscle of the uterus via keyhole surgery. This when the fibroid is mainly in the uterine cavity, it can be removed hysteroscopically by inserting a long thin camera through the cervix into the uterus. The fibroid is then cut away and removed through the cervix and vagina.

Hysteroscopic Myomectomy

Also called a Hysteroscopy is the removal of Fibroids growing in the cavity of the uterus.

WHAT TESTS ARE NEEDED BEFORE SURGERY?

At our practice, we like to make your surgery as safe and predictable as possible.

So we will:

Review your medications
Dilation and Curettage - the procedure to remove tissue from the lining of the uterus (endometrium)

We routinely perform a blood test on all patients before surgery, this test includes:

a full blood count,
blood group,
cholesterol levels,
kidney, liver and thyroid function, and
a diabetes screening test.

Depending on your medical history and as required we may also arrange:

Ultrasound—shows images of pelvic organs
Intravenous pyelogram —x-rays are taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein (done if the fibroids are affecting the ureters)

PREPARATION BEFORE A MYOMECTOMY

Preparing for Myomectomy Surgery

Our doctor will go over the specific instructions for pre-operative care, but generally, patients will need to:

Avoid eating after midnight, and on the day before surgery.
Ask a friend or family member to be at the hospital for support and comfort.

Manage Risk Factors

Talk to your doctor about ways to manage factors that may increase your risk of complications such as

Smoking
Drinking
Chronic diseases such as diabetes or obesity
The use of certain prescription medications

Other Pre Operative Preparation

Patients may also want to arrange for the food, drink, and medications they will require after surgery before they go to the hospital.

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.

What should I bring with me to the hospital?

A hospital representative will call you the evening before your admission and advise you on everything you need to know.

Generally, only a few things are required. These include

Bathroom items & personal toiletries
Clothing for your stay that is easy to put on and take off including pajamas, bathrobe, slippers
Your regular medications
Mobile phone, iPod, tablet, laptop, books, photographs, etc
Do not wear jewellery other than a wedding ring
If you have sleep apnea, bring your CPAP mask, tubing and machine.

Don’t forget to bring any X-rays and other important medical documents that may be relevant to your surgery.

Arrange for a ride home from the hospital. Also, arrange for help at home.

DAY OF A MYOMECTOMY

A myomectomy can be performed in a number of ways, depending on the location and number of lesions and the experience and preference of the surgeon.

After a general or a spinal anesthesia is administered, the steps are as follows:

Open or Laparotomy Myomectomy

a full abdominal incision and the peritoneal cavity is opened,
the uterus is incised,
the lesion(s) removed.
One or more incisions may be set into the uterine muscle and are repaired once the Fibroid has been removed.
Recovery after laparotomy surgery takes six to eight weeks.

Laparoscopy Myomectomy

Uses a laparoscopic or keyhole approach,
the uterus is visualized
the Fibroids located and removed.
Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does a laparotomic myomectomy
Laparoscopic myomectomy is not generally used on very large Fibroids.

Hysteroscopy Myomectomy

A Fibroid that is located in a submucous position (that is, protruding into the endometrial cavity) may be accessible to hysteroscopic removal.
Typically may apply primarily to Fibroid no greater than 5 cm, however, larger lesions have also been treated by hysteroscopy.
Recovery after hysteroscopic surgery is a few days.

Typically the procedure will take 1-2 hours but the duration required for each type of Myomectomy is dependant on various factors such as the number of Fibroids to be removed.

IMMEDIATELY AFTER A MYOMECTOMY

Pain Levels After a Myomectomy

You will have abdominal pain and discomfort for 7-10 days. You will be given medication to help control the pain.

What Are the recovery times?

For the least invasive procedure Myosure, patients can return to normal activities in a few weeks. For more invasive surgery this can extend to a few weeks.

How Long Will The Hospital Stay Be?

The vast majority of patients feel well enough to be discharged on the same day or up to 3 days depending on your procedure. This means staying overnight in the hospital for one or two nights is a possibility.

Everyone heals at different rates and surgery can vary in its complexity depending on a patient’s past medical history. You will be allowed home when you feel ready. No-one is ever pushed out of the hospital.

WHAT SHOULD I EXPECT AFTER A MYOMECTOMY?

How soon can I drive?

It is illegal to drive within 24 hours of a General Anaesthetic, therefore it is important that you arrange for someone to pick you up from the hospital.

Most patients feel ready to drive again after 3 days, however for your own safety; you should not drive until you have stopped taking any strong pain medications, and feel comfortable that you can break in a hurry.

STAGES OF RECOVERY AFTER A MYOMECTOMY

Depending on the type of Myomectomy the recovery times will vary.

As part of the Care Plan, your Post Treatment Reviews will be also outlined in your Recovery timeline.

After a myomectomy, if fertility is desired, you should wait for at least 4 months for the uterus to heal before starting to try to fall pregnant. In some cases, labour may carry a significantly higher risk of uterine rupture and an elective caesarean section is advised for future pregnancies.

POSSIBLE RISK OR COMPLICATIONS OF A MYOMECTOMY

Complications of the surgery include:

the possibility of significant blood loss,
the risk of Adhesion or scar formation around the uterus or within its cavity, and
the possible need to deliver a child in the future via cesarean section to avoid uterine rupture

Recurrence of Fibroids after a Myomectomy

It may not be possible to remove all lesions, nor will the operation prevent new Fibroids from growing.

Development of new Fibroids is not uncommon for patients undergoing a myomectomy.

Myomectomy During Pregnancy

Fibroids tend to grow during pregnancy but only the large ones causing endometrial cavity distortion could interfere with the growing pregnancy directly.

Generally, surgeons tend to stay away from operative interventions during the pregnancy because of the risk of haemorrhage and the concern that the pregnancy may be interrupted.

After a pregnancy, myomas tend to shrink naturally. However, in selected cases, myomectomy may become necessary during pregnancy, or also at the time of a caesarean section to gain access to the baby.