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Introduction :
Many women have benign tumors in their uterus called myomata uteri
or fibroids. These myoma may be silently present and cause no
problems. In many women, however, fibroids can cause excessive
and frequent menstrual periods, pelvic pain, infertility, and
recurrent pregnancy loss.
Severe anaemia can result from excessive uterine bleeding. Other
symptoms can include pelvic pressure on the woman's bladder or
rectum which may result in frequent urination or constipation.
Some women will experience pain during sexual intercourse (due
to an enlarged uterus).
What is a Myomectomy?
Myomectomy is a procedure in which uterine fibroids are surgically
removed from the uterus. Uterine fibroids (also known as myomas)
affect 30% of women. While many fibroids do not need treatment,
others can cause abnormal uterine bleeding, pressure, pain, or
other symptoms.
Removing the entire uterus (hysterectomy) is frequently done to
treat fibroids, but many women are looking for alternatives to
hysterectomy if they wish to have children or simply do not want
to lose their uterus. Unfortunately, many gynecologists are hesitant
to recommend myomectomy. As with any procedure, there are both
advantages and disadvantages to myomectomy. This site will provide
information to help you make an informed decision.
Myomectomy Procedures
There are numerous ways that doctors perform a myomectomy. The
type, size, and location of your fibroids determine which of the
following myomectomies might be recommended.
1. Laparotomy (Abdominal Myomectomy)
2. Laparoscopic Myomectomy
3. Hysteroscopic Myomectomy
4. Laparoscopic Myomectomy with Mini-Laparotomy
5. Laparoscopic Assisted Vaginal Myomectomy (LAVM)
In short, laparoscopic myomectomy does a pretty good job of taking
out pedunculated subserosal fibroids through the belly button
along with a few other "stab" locations in the abdomen,
hysteroscopic myomectomy is for submucosal fibroids that can be
removed vaginally, and laparotomy takes care of all fibroids no
matter their location, size, or number. Laparoscopic Myomectomy
with Mini-Lap allows for the removal of slightly larger subserosal
fibroids than what the laparoscope alone can handle -- but is
a relatively small 3" incision or less in the abdomen. LAVM
allows for the laparoscopic removal of subserosal fibroids from
the uterus with the total removal of fibroid material through
a vaginal incision.
Clearly, any myomectomy involving the use of laparoscope or hysteroscope
requires an endoscopic surgeon with a little more skills underneath
his/her belt than what is acquired from most medical schools today.
What are the advantages and disadvantages of laparoscopic
myomectomy?
The advantage of a laparoscopic myomectomy over an abdominal myomectomy
is that several small incisions rather than large ones are used.
It is important to understand that even a laparoscopic myomectomy
is real surgery, and often requires several weeks of recovery.
Another major factor in recovery time is motivation; I have found
motivation can be just as important in recovery as the type of
surgery.
One concern when there are multiple fibroids is of leaving smaller
myomas behind. Often it is necessary to feel the uterus to find
the smaller myomas; these likely would be left behind during a
laparoscopic myomectomy. To summarize, I think laparoscopic myomectomy
is best for pedunculated and superficial myomas. When there are
deep myomas and a large number of myomas, I think that it is possible
to repair the uterus better by doing an abdominal myomectomy.
Who benefits from a Myomectomy?
Myomectomy should be performed when infertility is an issue and
you have not been able to get pregnant or hold onto a pregnancy
because of the presence of uterine fibroids. If you don’t
happen to want a hysterectomy you are just plain out of luck because
myomectomy is for women who want to get pregnant. Well, not exactly.
Many gynaecologists will perform a myomectomy when the patient
chooses to keep her uterus for reasons other than future pregnancy.
So, under those circumstances, the ideal patient for this procedure
meets three basic requirements :
1. they have fibroids.
2. the fibroids are symptomatic.
3. There is no cancer.
Surgery
It used to be that a total abdominal hysterectomy (TAH), or the
removal of the fibroids through a large abdominal incision, was
the only type of mysterectomy available to women. But today the
development of improved surgical devices and innovative techniques,
such as Minimally Invasive Procedures (MIP), allow for less-invasive
procedures, shorter hospital stays, and reduced recovery times
Minimally Invasive Procedures (MIP):
o Laparoscopic myomectomy takes place under general anesthesia
or a regional (epidural) anesthesia. Several small 1/2 inch incisions
are made in the abdominal wall to place the laparoscope and other
instruments. Then, using techniques such as coagulation or electrosurgery,
the fibroids are removed and the uterine wall repaired. We use
a bipolar needle or laser to perform "myolysis" of the
fibroids. This does not involve surgically cutting into the uterus,
but instead, it uses either electrical current or laser energy
to coagulate the fibroids, which shrink to about half the size
after surgery.
o Hysteroscopic myomectomy is performed through the woman's cervical
canal and does not involve any abdominal incisions. A device called
a resectoscope cuts away the fibroids or an electrical current
"evaporates" the fibroids. It takes place under general
anesthesia or a regional (epidural) anesthesia.
The surgery needs between 2 and 4 days of hospitalisation. Full
Recovery needs 6 to 8 weeks after the surgery.
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