Myomectomy: A Minimally Invasive Treatment for Uterine Fibroids

Myomectomy

Myomectomy is a surgery to remove uterine fibroids (fibroids or leiomyomas) from the wall of the uterus without removing the uterus. Uterine fibroids are benign tumors that grow within or on the wall of the uterus. They are made of muscle cells and other tissues. Fibroids vary in size from tiny leiomyomas to large growths the size of a grapefruit or even larger. There are many types of fibroids based on their location within the uterus.

Myomectomy is an option for women who want to retain their uterus and fertility. Some common reasons women choose fibroidectomy over a hysterectomy include:

- Wanting to preserve fertility - Fibroids can interfere with getting pregnant and maintaining a pregnancy. Removing fibroids may help fertility.

- Younger age - Women who have not completed childbearing may choose fibroidectomy.

- Few or small fibroids - Removal of only the fibroids is possible if they are small in number and size.

Surgical Techniques for Myomectomy

There are few different surgical techniques a Myomectomy surgeon may use for fibroidectomy depending on the number, size, and location of the fibroids:

- Abdominal: Also called an open fibroidectomy, it is performed through a larger abdominal incision. This allows the surgeon better visualization but longer recovery time.

- Laparoscopic: Small incisions are made in the abdomen and a thin, lighted surgical instrument called a laparoscope is inserted. Other small surgical tools are used to remove the fibroids through the small incisions. Recovery is usually shorter than open fibroidectomy.

- Hysteroscopic: Specially designed instruments are inserted through the cervix and used to remove submucosal fibroids growing in the uterine cavity. No external incisions are needed.

- Robotic: The surgeon performs the surgery while sitting at a control console viewing a 3D image of the reproductive organs. Robot arms hold miniature surgical instruments used to remove fibroids through several small incisions. It provides improved precision and visualization over standard laparoscopy.

Risks and Recovery Time from Myomectomy

As with any surgery, there are risks involved with fibroidectomy including:

- Bleeding - Risk is higher if the fibroids are large or numerous. Blood transfusion may be needed.

- Infection of the incision sites or uterus. Antibiotics are usually prescribed.

- Injury to nearby organs like the bowels, bladder or blood vessels.

- Remaining or new fibroids developing later. Additional procedures may be needed.

Recovery time depends on the surgical approach and number/size of fibroids removed but typically includes:

- 1-2 weeks of light activity and time off work for abdominal approach.

- 1 week for laparoscopic surgery. Light exercise after a few days.

- Minimal recovery for hysteroscopic removal of small submucosal fibroids.

The Chance of Future Pregnancy After Myomectomy

A successful fibroidectomy can often restore fertility in women whose fibroids were impacting their ability to get pregnant. However, the chance of getting pregnant depends on factors like a woman's age, overall fertility prior to surgery, size and locations of fibroids removed. Some key points on pregnancy outcomes after fibroidectomy:

- Up to 80% of women under 35 will get pregnant within 1 year after fibroidectomy.

- Between 50-70% success rate for women ages 35-40. Fertility declines with increasing age as with all women.

- Removing only subserosal fibroids on the outer wall of the uterus has the highest pregnancy rates. Deep intramural or submucosal fibroids impact fertility more.

- The chance of miscarriage is slightly higher after fibroidectomy, around 15-20% compared to 12-15% in the general population. Careful monitoring of early pregnancy is recommended.

- The chance of Cesarean delivery is a bit higher as well due to the uterine scar from the prior surgery. Vaginal delivery is still possible.

When Repeated Surgery May Be Needed

In some cases, one fibroidectomy is not always sufficient to address a woman's fibroid issue permanently. Up to 30% of women can experience regrowth of fibroids or development of new ones within 5 years requiring another surgery. Risk factors for fibroid recurrence include:

- Black/African American ethnicity - Linked to higher levels of estrogen which promotes fibroid growth.

- obesity

- Family history of fibroids

- Large or deeply embedded fibroids at initial surgery. Not all may be removed.

So while fibroidectomy aims to treat fibroids and restore fertility potential, lifelong monitoring of the uterus with ultrasounds is usually advised since repeated procedures may be needed in some women over time. Close follow-ups allow prompt treatment if signs of new or returning fibroids occur.

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