Our Summary

This research paper focuses on the best way to remove leiomyomas, which are non-cancerous growths in the uterus also known as fibroids. The preferred method is through laparoscopy, a minimally invasive procedure using a small camera and thin instruments, especially for certain types of fibroids. However, the paper also notes that this method isn’t always appropriate. For instance, if the surgeon isn’t experienced enough, if the fibroid has undergone severe tissue death, if there’s suspicion of a cancerous form of fibroid, or if the fibroid is too large, a different approach might be needed. The paper also provides tips and tricks for the laparoscopic procedure, including removing the fibroid, suturing (stitching up) the uterine muscle, and preventing tissue from sticking together after surgery.

FAQs

  1. What is the recommended method of access for a myomectomy procedure?
  2. What are the main contraindications for a laparoscopic myomectomy?
  3. What techniques are commonly used in a laparoscopic myomectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the procedure, including the possibility of needing a blood transfusion, scarring, and potential impact on future fertility. It is important for the patient to have a thorough understanding of the procedure and its potential outcomes before making a decision.

Suitable For

Patients who are typically recommended for myomectomy include those with symptomatic intramural and sub-serous leiomyomas. Other factors that may indicate a need for myomectomy include severe symptoms, suspected leiomyosarcoma, and leiomyomas of excessive size. Patients who are not good candidates for myomectomy include those with severe necrobiosis and those with surgeons who are inexperienced in performing the procedure.

Timeline

Before myomectomy:

  • Patient consults with a gynecologist to discuss symptoms and treatment options for uterine fibroids
  • Gynecologist may recommend imaging studies such as ultrasound or MRI to confirm the presence and location of fibroids
  • Patient undergoes preoperative evaluations to assess overall health and suitability for surgery
  • Patient may be advised to stop certain medications or adjust their diet before surgery

After myomectomy:

  • Patient undergoes the laparoscopic myomectomy procedure, which involves making small incisions in the abdomen and using a camera and specialized instruments to remove the fibroids
  • Recovery time varies but typically involves a few days in the hospital and several weeks of limited activity
  • Patient may experience some pain, swelling, and discomfort after surgery, which can be managed with pain medication and rest
  • Patient follows up with their gynecologist for postoperative care and monitoring of any potential complications
  • Patient may experience relief from symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel

Overall, the goal of myomectomy is to improve quality of life and alleviate symptoms associated with uterine fibroids, while preserving fertility in women who wish to become pregnant.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with myomectomy surgery?

  2. How long is the recovery time after a myomectomy procedure?

  3. Will I still be able to conceive and have a successful pregnancy after myomectomy?

  4. Are there alternative treatment options to myomectomy that I should consider?

  5. How many myomectomy procedures have you performed, and what is your success rate?

  6. Will I need to undergo any additional testing or imaging before the myomectomy surgery?

  7. What type of anesthesia will be used during the surgery?

  8. How long will the surgery take, and will I need to stay overnight in the hospital?

  9. What can I expect in terms of pain management and post-operative care after the surgery?

  10. Are there any lifestyle changes or restrictions I should follow before or after the myomectomy procedure?

Reference

Authors: Dubuisson JB, O’Leary T, Feki A, Bouquet DE Jolinière J, Dubuisson J. Journal: Minerva Ginecol. 2016 Jun;68(3):345-51. Epub 2016 Feb 29. PMID: 26928417