Types Of Myomectomy

Over 80% of women will have experienced uterine fibroids before age 55, according to statistics. For some, these fibroids cause no issues, and they may never know they have them, but for others, they can lead to symptoms that affect their daily lives and make it difficult for them to function. These symptoms may include severe abdominal pain, heavy bleeding, and anemia, and OB/GYNs often recommend hysterectomy or one of many types of myomectomy surgery to eliminate the fibroids and their symptoms.

The type of surgery recommended to remove fibroids is usually based on the patient’s situation and whether a woman desires to maintain her fertility. While a myomectomy is considered to be the least invasive of the two and will preserve the woman’s ability to become pregnant, both of these surgeries are associated with long-term side effects. Today, we are going to go over what the differences are between different types of myomectomy and some of the known associated side effects.

What Types Of Myomectomy Surgery Are There?

There are five different techniques used for myomectomies, but all of them are designed to remove fibroids from where they are growing within and on the uterus. They all involve a surgeon attempting to remove the fibroids one at a time, doing the least amount of damage to the uterus as possible. Unfortunately, most myomectomies leave the uterus compromised, and if a future pregnancy were to occur, the woman would be a candidate for a mandatory C-section during delivery. The different types of myomectomy include the following.

Hysteroscopic Myomectomy

A hysteroscopic myomectomy, also known as a vaginal myomectomy, is a less-invasive procedure used to remove submucosal fibroids located inside the uterus. This technique is not suitable for other types of uterine fibroids, is one of the least performed methods, and is specifically used for these rare types of fibroids.

During the procedure, the surgeon inserts a small surgical instrument through the vagina and cervix to access and remove the fibroids. Usually it is done using a wire loop called a resectoscope, which cuts the fibroid with an electrically charged wire before removing it through the vagina. Recovery usually takes just a few days and can depend on how many fibroids were removed.

The Side Effects Of A Hysteroscopic Myomectomy

  1. Reactions to general anesthesia
  2. Damage to the cervix, such as abrasions
  3. Perforation of the uterus while dilating the cervix
  4. Incomplete removal of the fibroid (this could cause regrowth or require additional surgery)
  5. Formation of scar tissue in the uterine cavity, potentially affecting fertility
  6. Injury to the intestines or bladder
  7. Risk of infection
  8. Bleeding complications
  9. The rare but severe side effects of hysteroscopy may include:
    • Pregnancy-related issues like uterine rupture or abnormal placentation
    • Gas embolism, which is where gas bubbles get into the bloodstream, was noted to happen frequently in randomized trials during hysteroscopic fibroid removal.
    • Excessive fluid absorption, which can lead to dangerous conditions such as low sodium levels, excessive blood dilution, hypothermia, fluid in the lungs, brain swelling, or heart failure, can be life-threatening.
Uterine Fibroid Embolization in Atlanta, GA

Laparoscopic Myomectomy

This is the most popular fibroid removal surgery and the one most often used by OB/GYNs. During a laparoscopic myomectomy, the surgeon makes a few small incisions in the patient’s abdomen and inserts a laparoscope, which is a thin tool with a light and camera. Tiny surgical instruments are then used to remove the fibroids, with the surgeon watching a screen that shows the camera’s view. This method works best for fibroids that are easily accessible, but those deep inside the walls of the uterus may be impossible to remove. Another option when performing a laparoscopic myomectomy is to use robotic arms, which the surgeon controls for more precise movements, though this can make the surgery longer and costlier. Recovery time is generally between 4 and 6 weeks.

Complications After Laparoscopic Myomectomies

Studies have shown that complications following laparoscopic myomectomies have been on the rise in the last ten years. Experts stated that some of the reasons for this increase are that more women are postponing starting a family and then seeking treatment for fibroid-related infertility later in life when they are experiencing large or multiple fibroids. The study went on to point out a reason of particular concern: that there are a large number of OB-GYNs who perform these surgeries without sufficient training and who do not possess the expertise in removing fibroids through laparoscopic or electromechanical morcellation.

The Side Effects Of A Laparoscopic Myomectomy

  1. Common complications from general anesthesia (potentially more significant in robotic myomectomies due to the longer surgery time)
  2. Excessive blood loss (especially risky for women with anemia)
  3. Uterine injury or damage to nearby organs or the urinary system.
  4. Formation of uterine adhesions (scar tissue)
  5. Infection or blood clots
  6. Potential for fibroids to come back
  7. Complications during labor or delivery due to a compromised uterus.
  8. Possible unwanted hysterectomy (women must sign a statement allowing a full or partial hysterectomy if the surgeon deems the fibroids too numerous or large.)
  9. There is a risk of spreading cancer when using morcellation for the removal of fibroids.

Open Myomectomy

An open myomectomy is also called an abdominal myomectomy and is recommended if the patient has multiple or very large fibroids. This technique is the most invasive, carries the highest risk for complications, and takes the longest to recover from. During this procedure, the surgeon creates a long abdominal incision along the bikini line (much like a C-section) and works to extract each fibroid one at a time. If the fibroids are located high up in the uterus, making them difficult to access, the surgeon may need to create an additional incision that runs vertically. This extensive surgery involves multiple layers of suturing and has a recovery time of about 6 to 8 weeks.

Side Effects Of An Open Myomectomy

You may be surprised to know that the risks and complications of an open myomectomy are almost the same as those listed above for the laparoscopic technique; however, it takes longer to recover due to the longer incision, layers of sutures, and length of time under anesthesia.

UFE Is A Better Alternative To Any Type Of Myomectomy

No matter which type of myomectomy is used to remove fibroids, patients may face surgery-related complications or the recurrence of fibroids. Uterine fibroid embolization (UFE) is a non-invasive, non-surgical procedure that has been proven to be 90% effective in eliminating fibroids.

When performed by an expert interventional radiologist, UFE can safely and effectively eliminate fibroids regardless of their location, number, or size. The procedure works by cutting off the blood supply to the fibroids, causing them to shrink and die while preserving the uterus, which will allow a safe, natural childbirth in the future.

Unlike surgical procedures, UFE is done on an outpatient basis, eliminating the need for any type of hospital stay, and patients are normally back to their routine within a week, compared to the six-week recovery of any surgical myomectomy.

If you have been told that your uterine fibroid requires surgical treatment, contact the Atlanta Fibroid Center for a second option. Many of our patients have been advised by their OB/GYN that the only way to treat their fibroids is through surgery, and this is simply not true. Myomectomy and hysterectomy surgeries have many known short- and long-term side effects, and there is no reason to expose yourself to these treatments when UFE is an option.

Contact the experts at the Atlanta Fibroid Center for a consultation to see if you are a candidate for UFE and learn more about the advantages it has over any of the other types of myomectomy surgeries.

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