Therapy before the appearance of fibroids should be individualized according to the present symptomatology, the requirements of the patient, and the relative risks of each patient in particular.
Thus, a myomectomy is usually performed when treating severe menorrhagia is planned in a 26-year-old patient with multiple myomas. Still, in the case of a 42-year-old patient with the same findings, a set of options are presented.
The decision to perform a myomectomy versus a hysterectomy should be based on the patient’s desire to maintain fertility and put the uterus in it.
Myomectomy is the indicated treatment for uterine fibroids and is the most recommended for women who want to preserve fertility, preserving the uterus intact.
A myomectomy can be performed in different ways, depending on the fibroids’ size, number, and location.
Moreover, choose between an abdominal, laparoscopic, or hysteroscopic myomectomy, depending on the findings.
Myomectomy can be done through an abdominal or vaginal approach, which will depend on the location of the fibroids.
The abdominal approach can be performed using an open abdominal myomectomy or laparoscopically.
It is easy to remove fibroids, such as those attached to the outside of the uterus by a stem called pedunculated fibroids or superficial fibroids, or those near the outer surface of the uterus, called subserosal myomas; the pathway is used laparoscopic.
However, fibroids that grow deep in the uterine wall or submucosal fibroids, which are difficult to remove by laparoscopy, are candidates for abdominal myomectomy.
When fibroids are small and swollen in the uterine cavity, a vaginal hysteroscopic approach is usually used.
Known as “open” myomectomy, it is an essential surgical procedure that involves making an incision in the lower part of the abdomen, better known as “the bikini line,” and removing the uterine fibroids that have been previously located by ultrasound.
The uterine muscle is reconstructed, the abdominal incision is stitched, and antibiotics are given.
This procedure is performed under general anesthesia and requires hospitalization and postoperative rest for four to six weeks.
After a myomectomy, your doctor may recommend the practice of a cesarean section for future pregnancies.
This is indicated to reduce the chances of your uterus opening during labor.
The need for a cesarean section will depend on how deeply the fibroids were embedded in the uterus wall during surgical excision.
Any surgical procedure presents risks, and an abdominal myomectomy does not escape this reality. It can cause bleeding and injury to other abdominal organs, and about 5 percent of women develop an infection.
If you experience fever, wound infection, or abdominal pain after the surgery, consult your doctor immediately.
Laparoscopic myomectomy is performed through small external incisions.
To carry out this procedure, a viewing instrument called a laparoscope is inserted into the abdomen through a small incision in the abdominal wall, which is provided with a fiber-optic camera.
This device allows the manipulation of tiny surgical instruments to remove tumors.
Usually, a laparoscopy requires a smaller incision and a shorter recovery time than an abdominal myomectomy.
The minimally invasive laparoscopic myomectomy is performed with robotic assistance for greater precision and produces minimal tissue damage when the uterine wall is repaired.
A laparoscopic myomectomy, like any surgical procedure, presents some risks.
Complications may include bleeding, injuries to internal organs, and weakening of the uterus.
In general, an abdominal myomectomy is recommended in the case of women who plan future pregnancies.
It is an ambulatory surgical procedure recommended for patients with submucosal fibroids.
The patient is usually asleep during the procedure and lying on her back with her feet in the gynecological stirrups.
A speculum is placed in the vagina, introducing fluid into the uterine cavity to separate the walls.
A long, thin endoscope is inserted with a light and a camera that passes through the vagina and cervix into the uterus.
The doctor can look inside the uterus for fibroids and other problems, such as polyps.
Fibromas that protrude more than 50% can be removed with the built-in wire loop.
This small loop allows your doctor to remove a fibroid in the uterine wall using high-frequency electrical energy to suture the tissue.
Patients are usually sent home after the procedure, the hospital stay can last from 30 minutes to 2 hours, and the recovery time is usually 1-2 days.