Myomectomy is a procedure that involves the surgical removal of uterine fibroids from a woman’s uterus. The procedure is generally preferred as it leaves the woman’s uterus intact, and in most cases, increases the woman’s chances of pregnancy in women who wish to get pregnant post the removal of the uterine fibroids. Although your chances of getting pregnant highly increase post a myomectomy, it is not guaranteed that you will get pregnant.

Also known as the leiomyomas procedure, it helps in the removal of the noncancerous cells known as uterine fibroids that form inside the uterus of a woman during her childbearing years.

In India, almost 25 percent women in the age group of 25 to 50 years are noted to be suffering from uterine fibroids. Women who have undergone a myomectomy usually report an improvement in their symptoms of uterine fibroids, which include pelvic pressure as well as heavy menstrual bleeding.

Why do you need a myomectomy?

A myomectomy is usually needed when there is a requirement of the removal of fibroids from the uterus, while preserving the uterus at the same time. A myomectomy is a good choice in case:

• You suffer from pain that is not subsiding even with the use of medications.
• You are suffering from anaemia.
• Your fibroids are causing infertility.

How to prepare for a myomectomy

• Your doctor will generally advise you to stop eating or drinking at least 6 hours before the procedure.
• Inform the doctor of any medications that you are consuming regularly as these might interfere with the results of the procedure.

The Procedure

The procedure of myomectomy to be followed decided upon by the specialist tending to you at Apollo Spectra, depending on a variety of factors that include the following:

• Number of fibroids present in the uterus,
• Size of the fibroids as well as
• Exact location of the fibroids in the uterus

Depending upon the above listed factors, your doctor at Apollo Spectra may choose to follow any one of the following procedures:

Robotic or Laparoscopic Myomectomy: A Laparoscopic or robotic myomectomy is a minimally invasive procedure that involves the surgeon gaining access to the uterus through multiple tiny incisions on your body.

Robotic myomectomy: In a robotic myomectomy, several small incisions are made inside or near your belly button, through which the surgeon then inserts the instruments required in order to remove the fibroids. Once the instruments are inserted into the uterus, the surgeon then controls the instruments with the help of a console.

 Laparoscopic myomectomy: The surgeon inserts a narrow tube known as the laparoscope inside your abdomen. This tube has a camera fitted at one end in order to enable the surgeon to look inside your abdomen. The laparoscope is inserted into the abdomen through a small incision made inside or near your belly button.

Once the surgeon is able to gain access to the fibroids, they are then cut and removed from the body through an incision made onto the abdominal wall, for this purpose.

In rare cases, the fibroid that is cut inside the body is removed through the vagina. This is usually done when the fibroid is larger in size and it makes little sense to make larger cuts on the body for its removal.

The robotic and the laparoscopic procedures involve minor incisions to be made on the patient’s body, as compared to other procedures for the same purpose. This also means that the procedures leave smaller scars, need less recovery time, cause little blood loss as well as cause less pain to the patient.

Abdominal Myomectomy: In the abdominal myomectomy procedure, your surgeon will make an open abdominal incision in order to access and remove the fibroid from your body.

Either of the following two procedures may be followed:

  •  A vertical incision may be made, starting from the middle of the abdomen to just above your pubic bone, giving greater access to the uterus. This procedure is generally not followed.
  • A horizontal incision running about 2.5 centimetres long is made above your pubic bone to gain access to the fibroid.

Hysteroscopic Myomectomy: The Hysteroscopic myomectomy is a procedure that is generally performed when the fibroids are submucosal fibroids and cause a significant bulge in your uterine cavity.

In this procedure, the surgeon accesses the fibroids by inserting the instruments through the vagina and the cervix, up to your uterus. The steps followed generally involve the following:

  • A tiny, lit instrument known as the resectoscope is inserted through your vagina and cervix into your uterus in order to gain access to the location of the fibroid.
  • In order to provide proper examination of the uterus, it is expanded with the help of a clear liquid, like a salt solution for example, which is inserted into the uterus.
  • Once the surgeon is able to clearly identify and gain access to the fibroid, he starts shaving off the pieces of the fibroid, until the point where the fibroid gets aligned with the walls of your uterus.
  • Once this is done, the clear liquid is washed off from the uterus, which takes the shaved pieces of the fibroid along with it, out of your body.

Special Note: We take pride in the fact that the world’s largest Fibroid weighing 6.5 kilos was taken out by Padmashree awardee Dr. Malvika Sabharwal at Apollo Spectra Hospitals, Karol Bagh, New Delhi in December 2010.

Results of a myomectomy

Results of the myomectomy procedure usually the following:

• Improvement in fertility: the removal of the fibroids from the body generally boosts fertility and improves the woman’s chances of pregnancy. It is, however, important to note that you should wait for at least three months to attempt conception post a myomectomy, in order to provide the uterus with enough time to heal post the surgery.

• Relief from fibroid symptoms: post a myomectomy, you can usually expect relief from the symptoms of fibroids, such as pelvic pressure and pain as well as excessive menstrual bleeding.

Potential Risks of a myomectomy

The risks of a myomectomy generally include the following:

• A scar tissue may be formed due to the removal of the fibroids present in the uterine muscles.
• An infection may occur in the ovaries, the fallopian tubes or in the uterus itself.
• Some rare risks of the myomectomy procedure also include the following:
• Injury to the bowel or to the bladder
• Scarring that occurred due to the uterine incisions may lead to infertility
• A hysterectomy may be needed to be performed during the time that the myomectomy is being performed. This is generally required in case the removal of the fibroid causes such heavy bleeding that cannot be controlled or stemmed, without performing a hysterectomy.
• Rupturing or breaking open of the uterine scars in the later stages of the pregnancy or during delivery.

Recovery from myomectomy

The recovery time for the myomectomy procedure depends on the type of surgery that was performed in order to remove the fibroids.

• A Laparoscopic procedure requires a recovery time of no more than one to two weeks.

• A hysteroscopic myomectomy requires anything from a few days to about two weeks for total recovery.

• An abdominal myomectomy takes a longer time for recovery, ranging from about 2 weeks to almost 2 months for total recovery.

At Apollo Spectra, we ensure that you get the best treatment as well as recovery care in order to get back at your feet as quickly as possible and to ensure you of a smooth, convenient recovery. Our doctors use the latest technology and research to be able to provide the best treatment to our patients. A team of gynaecologists, specialists and other surgeons come together and study each individual’s case so as to recommend the best possible treatment plan, customised for the patient.

We at Apollo Spectra specialise in uterine fibroids, a part of complicated fertility problems and offer minimally invasive surgeries along with the latest treatments. Patients are also provided care post their surgery. Their comfort and safety is of prime importance for surgeons at Apollo Spectra.

FAQs

Is a myomectomy a major surgery?

Only the abdominal myomectomy procedure is considered a major procedure. The other two kinds are merely minor procedures.

What kinds of food promote the growth of the fibroids?

These include:
• Refined sugar containing foods
• Caffeine
• High fat and processed food
• Alcohol