Our Summary

This research paper discusses a surgical procedure called myomectomy, which is used to treat abnormal uterine bleeding, pain, and to preserve fertility. The procedure should cause as little damage as possible to the lining of the uterus. The surgeon’s skill level greatly affects the risk of complications. The way the surgery is performed is based on imaging of the fibroids (myomas). The placement of surgical instruments (ports) affects how easy the surgery is to perform, how long it takes, and the quality of the stitches.

The length of the surgical cut should be appropriate to the size of the fibroid to minimize bleeding and other complications. Using a specific type of coagulation (bipolar) on large blood vessels, while avoiding other issues, can reduce the risk of a type of bruise (hematoma) in the uterine muscle. High-quality surgery and some preventative measures can reduce the risk of tissue sticking together after surgery (adhesions).

Slowly rotating a specific surgical instrument (morcellator) and properly controlling the containment bag could minimize the risk of new fibroids and endometriosis. Keeping the pressure of the gas used in surgery (CO2) low can reduce the risk of spreading both benign (non-cancerous) and malignant (cancerous) cells.

Overall, the benefits of performing a myomectomy with a laparoscope (a minimally invasive surgery using a small camera) are greater than the risks of complications. Recent research shows that this type of surgery results in shorter hospital stays, less pain after surgery, less blood loss, and faster recovery compared to traditional open surgery.

FAQs

  1. What is the purpose of a myomectomy?
  2. What are potential complications of a myomectomy?
  3. How does a laparoscopic myomectomy compare to open surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about myomectomy is to discuss the potential benefits and risks of laparoscopic myomectomy compared to open surgery. Recent studies have shown that laparoscopic myomectomy can result in reduced hospitalization stays, postoperative pain, blood loss, and recovery time. It is important for patients to understand the advantages of this minimally invasive approach and weigh them against the potential risks, such as the need for morcellation during the procedure. Patients should also be informed about the importance of choosing a skilled and experienced surgeon to minimize the risk of complications.

Suitable For

Patients who are typically recommended for myomectomy include those who wish to preserve fertility, have abnormal uterine bleeding, and experience pain related to uterine fibroids. Myomectomy is also recommended for patients who have large or multiple fibroids, as well as those who have failed to respond to non-surgical treatments. Additionally, patients who have a desire to avoid a hysterectomy or have concerns about the potential complications of uterine fibroids may also be candidates for myomectomy. It is important for patients to discuss their individual circumstances with their healthcare provider to determine if myomectomy is the best treatment option for them.

Timeline

Before myomectomy:

  • Patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and pressure
  • Patient undergoes imaging tests such as ultrasound or MRI to confirm the presence and location of fibroids
  • Patient may try conservative treatments such as medication or hormone therapy to manage symptoms
  • Patient consults with a gynecologist or surgeon to discuss the option of myomectomy

After myomectomy:

  • Patient undergoes laparoscopic or abdominal surgery to remove fibroids
  • Recovery time varies but typically involves a hospital stay of 1-2 days
  • Patient may experience pain and discomfort, which can be managed with medication
  • Follow-up appointments are scheduled to monitor recovery and ensure no complications arise
  • Patient may experience improved symptoms such as reduced menstrual bleeding and pelvic pain
  • Patient may be advised to wait a certain period of time before attempting to conceive, depending on the type of myomectomy performed.

What to Ask Your Doctor

  1. What is the best surgical approach for myomectomy in my specific case (laparoscopic, robotic, hysteroscopic, abdominal)?

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

  3. How long is the recovery period after myomectomy and what can I expect in terms of pain and discomfort?

  4. Will my fertility be affected by the myomectomy procedure?

  5. How many myomas do I have and where are they located? Will all of them be removed during the procedure?

  6. Will I need to take any medication before or after the myomectomy?

  7. What is the likelihood of myomas recurring after the surgery?

  8. What is the success rate of myomectomy in terms of alleviating symptoms such as abnormal uterine bleeding and pain?

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

  10. How many myomectomies have you performed and what is your experience with this procedure?

Reference

Authors: Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Journal: Biomed Res Int. 2018 Mar 5;2018:8250952. doi: 10.1155/2018/8250952. eCollection 2018. PMID: 29693017