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Myomectomy -- Laparoscopic Surgery

Definition

This surgery involves removing fibroids from the wall of the uterus (womb). Fibroids are noncancerous tumors in the muscle of the uterus.

Reasons for Procedure

Myomectomy is done to relieve problems caused by fibroids without doing a hysterectomy (removal of the uterus). These problems can include:

  • Pelvic pain
  • Back pain
  • Pressure on the bladder
  • Abnormal vaginal bleeding
  • Difficulty becoming pregnant
  • Discomfort during sexual intercourse

The symptoms caused by fibroids are often successfully controlled with this procedure. This may include a return to a normal menstrual cycle and the ability to become pregnant.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a myomectomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Surgical wound infection
  • Recurrence of fibroids
  • Damage to other organs
  • Wall of the uterus may be weakened if a large fibroid is removed
  • Reactions to anesthesia
  • Need for special precautions in pregnancy (such as need to deliver by cesarean section )
  • Pelvic adhesions that can cause pain and/or bowel blockage
  • Problems found during surgery that make removal of the uterus necessary
  • Severe scarring, resulting in infertility

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
  • The use of certain prescription medicines

What to Expect

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Blood tests
  • Review your medicines
  • Dilation and curettage (D&C) —a procedure to remove tissue from the lining of the uterus (endometrium)
  • Ultrasound—shows images of pelvic organs
  • Intravenous pyelogram —x-rays taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein (done if the fibroids are affecting the ureters)

You should discuss with your doctor:

  • Whether you should have hormone treatment for 2-4 months before the procedure—This treatment shrinks fibroids. It makes them easier to remove and reduces the risk of excess blood loss during the procedure.
  • If cancer is found in the uterus—One option is to remove the uterus during the myomectomy.
  • Whether you should donate your own blood for the procedure.

Leading up to your procedure:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Arrange for a ride home from the hospital. Also, arrange for help at home.
  • Do not eat or drink for at least eight hours before the procedure.

Anesthesia

General anesthesia is used most often. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

The doctor will make a small cut in the navel. He will insert a laparoscope into the abdomen through the cut. A laparoscope is a tube with a tiny camera on the end. The doctor will use this to examine the abdomen. Two or three additional small cuts will be made in the abdomen. Other tools will be inserted through these cuts. The doctor will find each fibroid and remove it. In some cases, you may be given the drug Pitressin to reduce blood loss. After the fibroids are removed, the doctor will use stitches to close the incision area.

Laparoscopic View of Uterus
Laparoscopic View of Uterus
Copyright © Nucleus Medical Media, Inc.

Be aware that in some cases, the doctor may need to switch to an open surgery . During an open surgery, she will make a larger cut in the abdomen to do the surgery.

Immediately After Procedure

After the procedure, you will be:

  • Taken to the postoperative area
  • Watched for complications
  • Given IV fluids and medicines

How Long Will It Take?

1-2 hours

Will It Hurt?

Your doctor will give you pain medicine to help control the pain.

Average Hospital Stay

You will either stay overnight or leave the hospital the same day as your surgery.

Post-procedure Care

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

Full recover will take about 2-4 weeks. When you return home, do the following to help ensure a smooth recovery:

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Excessive vaginal bleeding (soaking more than one pad per hour) after the procedure
  • Excessive vaginal discharge that continues beyond one month after the procedure
  • Vaginal discharge has a foul odor
  • Severe abdominal pain
  • Headaches, muscle aches, dizziness , or general ill feeling
  • Nausea, vomiting, constipation , or abdominal swelling
  • Pain and/or swelling in one or both legs
  • Fibroid symptoms return after the procedure
  • Cough , shortness of breath, or chest pain
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • New, unexplained symptoms

In case of an emergency, call for medical help right away.

Revision Information

  • National Uterine Fibroids Foundation

    http://www.nuff.org

  • Women's Health.gov

    http://www.womenshealth.gov

  • Health Canada

    http://www.hc-sc.gc.ca

  • Women's Health Matters

    http://www.womenshealthmatters.ca

  • American Congress of Obstetricians and Gynecologists. Alternatives to hysterectomy in management of leiomyomas. Practice Bulletin. 2010;96.

  • Cohen SM, ed. Operative Laparoscopy and Hysteroscopy. New York, NY: Churchill Livingstone; 1996.

  • Myomectomy. Duke University Medical Center Reproductive Endocrinology and Infertility website. Available at: http://www.dukehealth.org/Services/Fertility/Programs/Surgery/Myomectomy?search%5Fhighlight=myomectomy. Accessed June 1, 2008.

  • Uterine fibroid treatment options. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patPub/uterineTreatments.shtml#my. Accessed June 1, 2008.

  • 6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.