Myomectomy is a surgical procedure that involves the removal of one or more uterine fibroids or non-cancerous tumors without removing the uterus.
Depending on the location of the fibroids, the myomectomy can be done by the pelvic area or by the vagina and cervix.
Removal of fibroids may allow a woman to become pregnant after surgery.
Am I a good candidate for myomectomy?
The reasons for choosing a myomectomy instead of a hysterectomy for uterine fibroids are:
- You plan to have children
- Your doctor suspects fibroids to interfere with your fertility
- You want to keep your uterus
Rate : Starting at £ 2 100
This package includes: the Surgery, anesthesia, use of the operating room, stay at the clinic, drugs, surgeon and anesthesiologist fees, convalescence at the hotel and transfers (Airport / Clinic / Hotel).
Anesthesia : General
Length of stay : 6 days (5 nights):3 nights at the clinic / 2 nights at the hotel
Scar : No scars
Time of absence before returning to work :You can return to work after one week. Do not exert yourself and keep moderate physical activity for 15 days.
Before the surgery:
At the first consultation, the following points are discussed with your doctor:
- Your health condition, your medical history and the drugs you are taking. Your doctor will tell you which medications to take or stop before your surgery.
- If you are taking blood thinners such as aspirin, be sure to talk to your doctor.
- You may need a laxative or enema before surgery.
- Some tests may be necessary before surgery.
- It is advisable to stop smoking, eat well and stay active
During the surgery :
Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approaches to myomectomy.
In abdominal myomectomy (laparotomy), your surgeon makes an open abdominal incision to access your uterus and remove fibroids. Your surgeon enters the pelvic cavity by one of two incisions:
- A horizontal line bikini incision that extends approximately 2.5 cm above the pubic bone. This incision follows your natural lines of skin, so that it usually results in a thinner scar and causes less pain than a vertical incision. It can be only 3 to 4 inches (8 to 10 centimeters), but can be much longer. Because it limits the surgeon’s access to your pelvic cavity, an online bikini incision may not be appropriate if you have a large fibroid.
- A vertical incision that starts in the middle of your abdomen and extends just below your navel just above your pubic bone. This gives your surgeon better access to your uterus than a horizontal incision and reduces bleeding. It is rarely used unless your uterus is so large that it exceeds your belly button.
Laparoscopic or robotic myomectomy
In laparoscopic or robotic myomectomy, minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions.
- Laparoscopic myomectomy. Your surgeon makes a small incision in or near your belly button. Then he inserts a laparoscope – a narrow tube with a camera – into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall.
- Robotic myomectomy. The instruments are inserted through small incisions similar to those of a laparoscopic myomectomy, and the surgeon controls the movement of the instruments from a separate console.
Sometimes the fibroid is cut into pieces and removed by a small incision in the abdominal wall. Other times, the fibroid is removed by a larger incision in your abdomen so that it can be removed without being cut into pieces. Rarely, the fibroid can be removed by an incision in your vagina (colpotomy).
Laparoscopic and robotic surgery uses smaller incisions than a myomectomy or laparotomy. This means that you can have less pain, lose less blood and return to normal activities faster than with a laparotomy.
To treat fibroids that swell significantly in your uterine cavity (submucosal fibroids), your surgeon may suggest a hysteroscopic myomectomy. Your surgeon accesses and removes fibroids using instruments inserted into the vagina and cervix.
- A hysteroscopic myomectomy usually follows this process:
Your surgeon inserts a small illuminated instrument – called a resectoscope because it cuts (resects) tissues using electricity or a laser beam – through your vagina and your cervix and into your uterus.
A clear liquid, usually a sterile salt solution, is inserted into your uterus to widen your uterine cavity and allow for uterine wall examination.
Using the resectoscope, your surgeon shaves the pieces of the fibroid until it aligns with the surface of your uterine cavity.
The removed fibrous tissue is washed with the clear fluid that is used to develop your uterus during the procedure.
Rarely, your surgeon can use a laparoscope inserted through a small incision in your abdomen to see the pelvic organs and monitor the outside of the uterus during a complicated hysteroscopic myomectomy.
After the surgery :
When you leave the hospital, your doctor will prescribe oral pain medications, explain how to take care of yourself, and discuss restrictions on your diet and activities. You can expect a few vaginal spots or staining for a few days up to six weeks, depending on the type of procedure you have had.
The results of the myomectomy can include:
- Symptom Relief: After myomectomy surgery, most women experience relief from bothersome signs and symptoms, such as excessive menstrual bleeding and pelvic pain and pressure.
- Improving Fertility: Removing submucosal fibroids by hysteroscopic myomectomy can improve fertility and outcome of pregnancy. After a myomectomy, wait at least three months before attempting conception to allow sufficient time for the uterus.
- Tiny tumors (seedlings) that your doctor does not detect during surgery may eventually develop and cause symptoms. New fibroids, which may or may not require treatment, may also develop. Women with only one fibroid have a lower risk of needing treatment for additional fibroids – often referred to as recurrence rates – than women with multiple fibroids.
How is myomectomy performed?
The surgeon can choose one of three surgical approaches to myomectomy depending on the size, number and location of your fibroids.
The surgical removal of one or more fibroids is performed either:
- Either by opening of the belly (laparotomy),
- Either by laparoscopy,
- Exceptionally vaginally.
To see also :