Our Summary

This research paper looked at the outcomes of two types of surgery for removing uterine fibroids (non-cancerous growths in the uterus): laparoscopic surgery (a less invasive surgery using small incisions) and laparotomic surgery (a more traditional surgery with larger incisions). The study also examined the effect of ligating (tying off) the uterine arteries during these surgeries.

The study found that for patients who had more than two fibroids removed without tying off the uterine arteries, the laparotomic surgery resulted in less bleeding, shorter operation time, and shorter hospital stay. But for patients who had two or less fibroids removed, there wasn’t much difference between the two types of surgery.

However, if the uterine arteries were tied off during surgery, there was less bleeding in both types of surgeries. The study also found that smaller fibroids (less than 3 cm) were more likely to come back after laparoscopic surgery and if the uterine arteries were not tied off. But for larger fibroids (more than 3 cm), the recurrence rates were similar regardless of the type of surgery or whether the arteries were tied off.

The study concluded that tying off the uterine arteries might be a good addition to fibroid removal surgery, especially for laparoscopic surgery and when more than two fibroids are being removed, because it could reduce bleeding and the chance of fibroids coming back.

Of the patients who had their uterine arteries tied off, 24 became pregnant and 14 of these pregnancies resulted in live births.

FAQs

  1. What are the main differences in outcomes between laparoscopic surgery and laparotomic surgery for the removal of uterine fibroids?
  2. How does ligating the uterine arteries affect the outcomes of fibroid removal surgeries?
  3. Is there a correlation between the size of the fibroids and their recurrence after surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss with your surgeon the option of ligating the uterine arteries during the surgery. This additional step may help reduce bleeding and the risk of fibroids recurring, especially if you are having multiple fibroids removed or undergoing laparoscopic surgery. Additionally, if you are planning on becoming pregnant in the future, it is important to discuss this with your doctor as the procedure may impact fertility.

Suitable For

In general, patients who are recommended for myomectomy are those who have symptomatic fibroids that are causing heavy menstrual bleeding, pelvic pain, pressure symptoms, or infertility. Myomectomy is often recommended for younger women who wish to preserve their fertility, as it allows for the removal of fibroids while leaving the uterus intact.

Patients who have smaller fibroids, fewer fibroids, and who are not experiencing severe symptoms may be good candidates for laparoscopic myomectomy, as it is a less invasive option with shorter recovery times. However, patients with larger fibroids, multiple fibroids, or who have had previous surgeries in the pelvic area may require a laparotomic myomectomy for better outcomes.

Additionally, patients who are planning to become pregnant in the future may benefit from myomectomy, as fibroids can sometimes interfere with fertility or cause complications during pregnancy. It is important for patients to discuss their individual symptoms, medical history, and future fertility goals with their healthcare provider to determine if myomectomy is the right treatment option for them.

Timeline

Before myomectomy:

  1. Patient consults with gynecologist about symptoms such as heavy menstrual bleeding, pelvic pain, or pressure.
  2. Gynecologist diagnoses patient with uterine fibroids through physical examination, ultrasound, or MRI.
  3. Patient and gynecologist discuss treatment options, including myomectomy.
  4. Patient undergoes pre-operative tests and evaluations to ensure they are healthy enough for surgery.

After myomectomy:

  1. Patient undergoes laparoscopic or laparotomic surgery to remove fibroids.
  2. If uterine arteries are tied off during surgery, there may be less bleeding and lower risk of fibroid recurrence.
  3. Patient stays in hospital for a few days post-surgery for monitoring and recovery.
  4. Patient experiences pain, cramping, and spotting as part of the recovery process.
  5. Patient follows post-operative instructions for pain management, wound care, and physical activity.
  6. Patient has follow-up appointments with gynecologist to monitor recovery and check for any complications.
  7. Patient may experience relief from symptoms such as heavy menstrual bleeding and pelvic pain.
  8. Patient may consider future fertility options, as myomectomy can improve chances of successful pregnancy.

What to Ask Your Doctor

Questions a patient should ask their doctor about myomectomy:

  1. What type of surgery (laparoscopic or laparotomic) do you recommend for my fibroid removal and why?
  2. Are there any specific factors about my fibroids (size, number, location) that would make one type of surgery more suitable for me?
  3. What are the potential risks and benefits of tying off the uterine arteries during my surgery?
  4. How likely is it that my fibroids will come back after surgery, and does tying off the uterine arteries affect this likelihood?
  5. How will tying off the uterine arteries during surgery affect my chances of getting pregnant in the future?
  6. Are there any alternative treatments or procedures that I should consider before deciding on myomectomy?
  7. What is the expected recovery time and post-operative care for each type of surgery?
  8. How often will I need follow-up appointments or imaging tests to monitor my fibroids after surgery?
  9. Can you provide more information about the specific outcomes and success rates of myomectomy procedures you have performed in the past?
  10. Are there any lifestyle changes or medications I should consider before or after myomectomy to improve my overall health and reduce the risk of fibroid recurrence?

Reference

Authors: Akbaba E, Kilicci C. Journal: Ann Ital Chir. 2023;94:498-505. PMID: 38051504