Definition and Overview

A myomectomy is a surgical procedure used to remove uterine fibroids or leiomyomas. These are benign growths that occur in women of childbearing age, but can also sometimes affect younger or older women.

The purpose of the procedure is to remove a uterine fibroid that is causing serious symptoms including heavy menstrual bleeding and painful intercourse, among others. Since the physical structure of the uterus is typically damaged by the growth, the procedure is also used to reconstruct the organ, with the goal of leaving it as intact and normal as possible so the patient’s ability to have children will not be affected. This is the difference between a myomectomy and a hysterectomy, which removes the entire uterus.

Who Should Undergo and Expected Results

A myomectomy can bring relief to women who are experiencing symptoms related to or caused directly by any of the different types of uterine fibroids, such as:

  • Subserosal fibroids – These are fibroids that develop on the serosa or the outside of the uterus.
  • Intramural fibroids – These are the most common fibroids that grow on the endometrium or the inner lining of the uterus, causing the womb to expand as the fibroid grows.
  • Pedunculated fibroids – These are subserosal fibroids that develop a slender base or stem.
  • Submucosal fibroids – These are the rarest type of fibroids that grow on the myometrium or the inner lining of the uterus.
    As these fibroids continue to grow in size, they may cause some symptoms, such as:

  • Heavy menstrual bleeding

  • Pelvic pressure
  • Pelvic pain
  • Prolonged menstrual periods (usually lasting more than seven days)
  • Frequent urination
  • Constipation
  • Back pain
  • Leg pain
  • Difficulty emptying the bladder
  • Painful intercourse
  • Enlarged abdomen
    Although the exact cause of fibroids is unclear, they have been associated with various risk factors, namely:

  • Hormonal changes and imbalances

  • Family history of fibroids
  • Pregnancy
  • Age
  • High body weight
    A myomectomy is preferred over a hysterectomy if the patient plans to have children in the future, wishes to keep her uterus, or is showing symptoms of infertility as a side effect of the fibroids.

However, although a myomectomy has very high success rates and can effectively remove and treat existing fibroids, it does not guarantee against future recurrences. Younger women, as well as those who have had multiple fibroids, face a higher risk of developing more in the future.

How Does the Procedure Work?

There are several ways to perform a myomectomy. The surgeon will decide on what to use depending on the quantity, size, and location of the fibroids that have to be removed. The different types of myomectomies include:

  • Abdominal myomectomy – This is a major open surgery that requires one long incision in the lower abdominal region and in the area of the uterus where the abnormal growth is found. If the fibroid is too deep, the incision may reach as deep as the muscles, which extends the patient’s recovery time. An abdominal fibroid removal surgery is performed while the patient is under general anaesthesia. Due to its complexity, patients who undergo this procedure are required to stay in the hospital for at least two nights after the procedure. The recovery downtime is also longer at around four to six weeks.

  • Laparoscopic myomectomy – Although less invasive than an abdominal myomectomy, this type of surgery can only remove certain types of fibroids. It usually cannot remove multiple, large, and those fibroids that are deeply embedded in the uterine wall. When used, however, the procedure requires only four tiny incisions in the lower abdominal area to allow special surgical tools to access the uterus. These tools include the laparoscope, a thin, lighted tube with a scope attached to one end. This procedure requires an overnight hospital stay and takes four weeks to recover from. It also causes minimal scarring, i.e. four small scars that are barely visible.

  • Hysteroscopic myomectomy – This type of myomectomy is only appropriate for patients who suffer from submucosal fibroids (or fibroids in the uterine cavity), as the procedure is not designed to remove fibroids that develop within the uterine wall. This is a less invasive procedure that can be done on an outpatient basis. The procedure is performed by placing a speculum in the vagina and inserting a long, thin telescopic tube through the cervix to access the uterine cavity. The surgeon then lifts the walls of the uterus using a special type of fluid. This allows the instruments to easily shave off the fibroids. This procedure does not leave any scars, and the patient can resume normal activities following about four days of rest.

    Possible Risks and Complications

All types of myomectomies come with the common surgical risks, such as:

  • Bleeding
  • Blood clots
  • Infection – Patients who suffer an infection will be given medications and will be monitored for up to six weeks, during which they will be asked to make regular follow-up visits to the doctor.
    On the other hand, some common yet mild symptoms that patients may experience following a fibroid removal surgery include:

  • Cramping

  • Light bleeding or spotting
    However, a greater number of risks and complications associated with fibroid removal are linked to abdominal myomectomies. These risks include:

  • Severe blood loss – In many cases, the patient may require a blood transfusion.

  • Scarring – Due to the large incision made during the procedure, it leaves a large noticeable scar near the bikini line, much like the one left after a caesarean procedure.
  • Caesarean childbirth – Patients who have had an abdominal myomectomy are strongly recommended to have a C-section if they need to give birth in the future. This is because uterine fibroids and fibroid removal sometimes affect the wall of the uterus, making it unable to bear the weight during pregnancy.
    Laparoscopic myomectomies also come with some risks, although they are rare. One major risk is the tendency for the uterus to become weaker. As such, an abdominal myomectomy is the preferred choice for patients who plan on getting pregnant in the future.

    Reference

  • Ferri FF. Uterine fibroids. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier Mosby; 2016.1271-2.

  • Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;12:CD005073. PMID: 25541260 www.ncbi.nlm.nih.gov/pubmed/25541260.

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