What is myomectomy?
Myomectomy is a surgical procedure that removes uterine fibroids – non-cancerous tumors that can originate from the muscle and connective tissue of the uterus. More than 50% of women will be diagnosed with uterine fibroids in their lifetimes, but only a small fraction of those will have symptoms that require treatment. In some cases, uterine fibroids can cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. They can somtimes interfere with fertility and pregnancy. (Click here for more information on uterine fibroids and treatments)
Will my myomectomy impair my ability to conceive?
Women have many medical and surgical options for the management of uterine fibroids. If surgery is needed, myomectomy is the preferred fibroid treatment for women who want to become pregnant.
How is myomectomy performed?
A myomectomy can be performed in several ways, often depending on the location, size and number of uterine fibroids. Removal of very large uterine fibroids may require a full abdominal incision (also called “open” surgery). Recovery after this kind of surgery usually takes four to six weeks.
Fortunately, minimally invasive myomectomy can be performed with laparoscopy using only small cuts in the abdominal wall. With this approach, special tools are used to break apart and remove the uterine fibroids through the surgical openings. Compared to open surgery, laparoscopy offers the following potential benefits:
- Significantly less pain
- Less blood loss
- Fewer complications
- Less scarring
- A shorter hospital stay
- A faster return to normal daily activities
One possible disadvantage of laparoscopy compared to open surgery is a lower level of access and visibility for the surgeon. However, another approach, called da Vinci Myomectomy, offers the advantages of laparascopy combined with improved surgical control and access. With the da Vinci Surgical System, small incisions are used to introduce miniaturized surgical instruments and a high-definition 3D camera. Operating from a da Vinci console a few feet away, Dr. Garofalo views a magnified, high-resolution 3D image of the surgical site. State-of-the-art computer technologies convert Dr. Garofalo’s hand movements into precise micro-movements of the da Vinci instruments.
Due to the increased risk of bleeding, a myomectomy is never performed during pregnancy.
What risks or disadvantages are associated with myomectomy?
Blood loss and the need for blood transfusion are the most common risks during myomectomy and are seen more commonly with very large and multiple fibroids. When difficulties are encountered during laparoscopic or da Vinci myomectomy, a full abdominal incision may be needed in order to safely accomplish the goals of the procedure. Although this happens in only a small percentage of cases, everyone undergoing laparoscopic or da Vinci surgery should be prepared for this possibility.
If pregnancy occurs after any kind of myomectomy, there is a small risk of uterine rupture, about 1 in 200 chance. In some cases, a cesarean section may be recommended in order to prevent uterine rupture. This depends in part on the size, location, and number of uterine incision made during myomectomy.
After myomectomy, uterine fibroids return in about 50% of women. Talk to Dr. Garofalo about fibroid recurrence what your options could be if this occurs.
What is the recovery period following myomectomy?
Most patients are fully recovered and ready to return to full activity less than two weeks after extensive laparoscopic or da Vinci procedures. As a general rule, you should feel better every day after the procedure.
Can a myomectomy improve my fertility?
Uterine fibroids can interfere with fertility by blocking the Fallopian tubes or by obstructing blood flow to the uterine lining, making it more difficult for an implanted embryo to grow and develop. In these cases, myomectomy can remove the obstructions, improve fertility, and reduce the likelihood of fibroid-related infertility and miscarriages. Dr. Garofalo will work with your infertility doctor to determine whether your type of infertility is likely to benefit from myomectomy.
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