Uterine Fibroid Tumor Treatment Myomectomy

Every year, over 600,000 hysterectomies are performed in the United States. In contrast, less than 40,000 myomectomies are performed. A myomectomy surgically removes fibroid tissue while leaving the rest of the uterus alone. It is the surgery recommended for women who wish to become pregnant after fibroid surgery. A myomectomy may also help control leiomyoma symptoms until menopause, when naturally lower estrogen levels prevent further fibroid growth.

A Myomectomy is the surgery recommended for women who wish to  become pregnant after fibroid surgery.Laparotomy

For large fibroids, or to remove growths buried in the uterus wall, a laparotomy is the recommended form of myomectomy. A laparotomy is also recommended if future fertility is an issue.

A laparotomy removes fibroid tissue through an incision in the abdomen. The procedure is major surgery and a woman can expect to spend two to three days in the hospital after the operation. Recovery time varies from two to six weeks.

Once the fibroid is removed, careful repair of the uterine wall is necessary to help prevent pelvic adhesions, or scars, which can lower fertility rates. The clear view of the uterus offered by laparotomy reduces the chance of pelvic adhesions. Less invasive techniques have a greater chance of uterine wall scarring.

Laparoscopy (Laparoscopic Myomectomy)

A laparoscopy, or laparoscopic myomectomy, is less invasive than a laparotomy. A small incision is made in the abdomen, and a hollow tube called a laparoscope is inserted. Through this tube, the surgeon is able to view the uterus and remove fibroid tissue in small pieces. A laparoscopy may use surgical tools to cut away the fibroid, or use a laser or electrical current to vaporize tissue.

Laparoscopy works well for fibroids growing on the outside of the uterus. The procedure has definite limits. Only small fibroids can be removed, and then only if they can be easily seen. A laproscopy cannot repair the uterus as well as a laparotomy, and the risk of pelvic adhesions is higher.

Hysteroscopic Myomectomy

A hysteroscopic myomectomy inserts a tube called a hysteroscope through the vagina and into the uterus. Small leiomyoma may then be removed. The procedure can be performed as an out-patient procedure and has a recovery rate of two to three days. If the fibroid is buried in the uterine wall, a hysteroscopic myomectomy will not be possible.

Hormone Therapy and Surgery

A course of hormone therapy is often recommended before surgery. GnRH agonists shrink leiomyoma, making the growths easier to remove.

Laparoscopic Myomectomy with Mini-Laparotomy

Occasionally a laparoscopy is combined with a small abdominal incision. This mini-laparotomy is usually only three inches long. The surgeon is better able to repair the uterus than with laparoscopy alone.

Laparoscopic Assisted Vaginal Myomectomy (LAVM)

A LAVM uses laparoscopy to surgically cut away the fibroid from the uterus. A vaginal incision is made to remove the pieces of fibroid from the uterus. This method has the advantage of leaving virtually no visible scarring, and offers a relatively fast recovery time.

Complications

As with any surgery, a myomectomy carries with it the chance of infection, blood loss, and organ damage. In addition, postoperative uterine rupture at the scar is possible. Risk of uterine rupture appears to be higher with the less invasive techniques because of the limited ability to repair the uterus. Rupture is not common: only one percent of women who undergo myomectomies suffer from this condition.

Regrowth of the leiomyoma is possible after the operation. Between twenty to forty percent of women require further surgery due to regrowth.

Women undergoing the procedure should be aware that, if severe complications arise, a hysterectomy may be necessary.

Pregnancy Issues

The chance of postoperative uterine rupture increases with pregnancy; the rate reported is five percent. Extensive pelvic adhesions may necessitate birth by caesarean section. Should pelvic adhesions block the ovaries, infertility may result.

Post-myomectomy chances of becoming pregnant are encouraging: 55 percent of women who have myomectomies due to fibroid-related infertility can get pregnant after the operation.