Figure (uterine fibroid) Injecting vasopressin into fibroid
Myomectomy (Surgical Removal of Fibroids)
Fibroids that are large enough to cause significant symptoms or rapidly growing fibroids may require surgery. Removal of only the fibroids, rather than the entire uterus, is called a myomectomy. Myomectomy is most often performed when the woman desires a future pregnancy or when she wishes to retain her uterus. Today, there are several options available for this surgery. In most cases, the size and location of the fibroids will det
ermine the appropriate surgical technique. Small fibroids may be removed through less invasive hysteroscopy or laparoscopy procedures, but large, multiple, or inaccessible fibroids
Figure (uterine fibroid) After suturing of fibroid bed.
usually require laparotomy for removal.
During a laparotomy, the physician will make an incision in the abdominal wall to remove the fibroids from the uterus. It usually takes about four to six weeks for a complete recovery. After a patient has undergone this surgery, a cesarean section may be needed for delivery because the muscular wall of the uterus may be weakened by the removal of many or large fibroids. The physician can make this determination at surgery.
The two major concerns with performing a myomectomy are minimizing blood loss and preventing surgically induced adhesions (scar tissue) that may impair future fertility. In rare cases, uncontrolled bleeding may require a hysterectomy. Sometimes women bank their own blood several weeks before myomectomy in case they might need a blood transfusion. If a woman and her physician decide that myomectomy is the best option, there are other risk factors that will need to be discussed. There is a chance that fibroids will reoccur and require further surgery. Pelvic adhesions may form which can impair fertility by affecting the tubes or ovaries. A laparoscopy can be used to evaluate any postoperative adhesions.
Small submucous fibroids located within the uterine cavity may be removed with operative hysteroscopy. During this procedure, the physician will insert a hysteroscope through the cervix into the uterus. Surgical instruments are then inserted through a channel in the hysteroscope to remove fibroids located within the uterine cavity. Generally, women can return to their normal activi
ties within two days after operative hysteroscopy, and complications are rare.
Figure (uterine fibroid) Enucleation of fibroid
In some cases, operative laparoscopy may be used to remove the fibroids if they are located on the outside wall of the uterus. During operative laparoscopy, the physician places a laparoscope into the abdomen through a small incision near the navel
and then uses surgical instruments to remove the fibroids. Recovery time is usually two to seven days. A new technique, called myolysis, in which the fibroid is at least partially, if not completely, destroyed by electro surgery or other means is being developed.
If a woman has large fibroids that are symptomatic, and pregnancy is not desired, a hysterectomy or surgical removal of the uterus may be recommended. A vaginal hysterectomy, which removes the uterus through the vagina, or an abdominal hysterectomy, which requires a laparotomy, may be necessary. Recovery time is usually two to six weeks. Nowadays it can be performed through Laparoscopy even if the uterus is large. Recovery is faster compared to laparotomy