What ıs Myomectomy?
Myomectomy is a procedure that involves the surgical removal of fibroids located in the uterus. Fibroids are mostly benign (non-cancerous) tumors that develop in the muscular layer of the uterus. Depending on their size and location, they may cause various symptoms; however, in some cases, they may not cause any symptoms at all. Myomectomy is an effective surgical method used to treat problems caused by fibroids [1].
ACOG (American College of Obstetricians and Gynecologists) defines myomectomy as a recommended method in the surgical treatment of symptomatic fibroids in patients who wish to preserve the uterus or plan to become pregnant in the future [1].
Types of Myomectomy
Myomectomy varies according to the way it is performed. ACOG recommends choosing a minimally invasive approach whenever possible [1]. The most common types of myomectomy are:
- Laparoscopic Myomectomy: A minimally invasive method in which fibroids are removed with the help of a camera (laparoscope) and surgical instruments through small incisions made in the abdominal area. The recovery process is faster compared with open surgery.
- Hysteroscopic Myomectomy: Preferred when the fibroids are located inside the uterus. Surgical instruments are passed through the vagina and cervix to reach the fibroids; no external incision is made.
- Open Surgical Myomectomy (Laparotomy): Performed when large or multiple fibroids need to be removed. A larger incision is made in the abdominal area; the recovery process is longer compared with other methods.
Who Is Myomectomy Performed For?
According to ACOG, myomectomy is considered a primary surgical option in patients diagnosed with symptomatic fibroids who wish to preserve the uterus or plan pregnancy in the future [1]. It may be an appropriate treatment option for women experiencing the following conditions:
- Heavy menstrual bleeding or abnormal bleeding between periods
- Pelvic pain or a feeling of pressure
- Difficulty conceiving or recurrent miscarriage
- Urinary tract problems caused by fibroids
- Swelling or a feeling of fullness in the lower abdomen
What Are the Symptoms of Fibroids?
Fibroids may not cause any symptoms in some women and may only be detected during routine examinations. In symptomatic fibroids, the following symptoms may occur:
- Difficult and heavy menstrual bleeding
- Pain in the back and groin area
- Burning or pain during urination
- Swelling in the abdomen and lower abdomen
- Pain during sexual intercourse
A specialist gynecologist should be consulted for the diagnosis of fibroids. The diagnostic process includes pelvic examination, ultrasound, and, when necessary, pelvic MRI imaging [2].
How Is Myomectomy Surgery Performed?
Myomectomy surgery is performed by laparoscopic (closed) or open method depending on the size, number, and location of the fibroid [1].
Laparoscopic myomectomy is performed with the help of a camera and instruments through small incisions made in the abdominal area. After the procedure, the patient is usually kept under observation in the hospital for 1 night; the average recovery period is 3-4 weeks.
Open myomectomy (laparotomy) is performed through a full incision in the abdominal area. It is preferred for large and widespread fibroids. After surgery, an average hospital stay of 2-3 days may be required; the recovery period is 4-6 weeks.
In both methods, the duration of surgery may vary between approximately 1-2 hours. ACOG states that there is a risk of new fibroid development after myomectomy and that patients should be informed about this [1].
Recovery Process After Myomectomy
The recovery process after myomectomy varies depending on the surgical method used [1][2]:
- Laparoscopic / Hysteroscopic methods: Recovery is generally faster; light daily activities can be resumed within a few days. Full recovery is completed within 3-4 weeks.
- Open surgery: The recovery process may take 4-6 weeks. During this period, heavy lifting and intense exercise should be avoided.
Mild pain, bleeding, or discharge may occur during the recovery period; these findings are normal and decrease over time. Doctor approval should be obtained before sexual intercourse.
How Is Myomectomy Performed in Single Patients?
In single patients, the laparoscopic method is preferred for fibroid surgery. Thanks to this approach, external incisions are kept to a minimum, the recovery process is accelerated, and uterine integrity is preserved for patients who wish to have children in the future [1]. Before surgery, the size, spread, and number of fibroids are evaluated and a surgical plan is created.
Frequently Asked Questions
The removed fibroids do not come back; however, new fibroids may develop. ACOG states that patients should be informed about this risk in advance [1].
Yes. Myomectomy is a uterus-preserving method; therefore, it is preferred in patients who wish to become pregnant. However, in some cases, internal adhesions may develop, and delivery may take place by cesarean section [1].
The laparoscopic method takes an average of 1-2 hours, and open surgery also takes an average of 1-2 hours. The duration may vary depending on the size, number, and location of the fibroids.
No. In fibroids that do not cause symptoms, a wait-and-see (observation) approach may also be considered. The treatment decision should be made by considering the severity of symptoms, the size of the fibroid, and the patient’s future pregnancy plans [1].
Diagnosis is made through pelvic examination, ultrasound, and, when necessary, pelvic MRI imaging. It is recommended to consult a specialist gynecologist for a definitive diagnosis and treatment plan [2].
References
- American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas. Obstetrics & Gynecology, 2021. (https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/06/management-of-symptomatic-uterine-leiomyomas)
- American College of Obstetricians and Gynecologists (ACOG). Uterine Fibroids – Patient FAQ. (https://www.acog.org/womens-health/faqs/uterine-fibroids)
- Mayo Clinic. Myomectomy – Overview, Surgical Approaches and Recovery. (https://www.mayoclinic.org/tests-procedures/myomectomy/about/pac-20384710)