Myomectomy—Laparoscopic Surgery
En Español (Spanish Version)

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 the 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 medications
What to Expect
Prior to Procedure
Your doctor may do the following:

  • Physical exam
  • Blood tests
  • Review your medications
  • 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 medications. You may be asked to stop taking some medications up to one week before the procedure.
  • 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
A small cut will be made in the navel. A laparoscope will be inserted into the abdomen through the cut. A laparoscope is a tube with a tiny camera on the end. It will be used to examine the abdomen. Two or three additional small cuts will be made in the abdomen. Other tools will be inserted through these cuts. Each fibroid will be located and removed. In some cases, you may be given a medication to reduce blood loss. After the fibroids are removed, the incision area will be closed with stitches.

Laparoscopic View of Uterus

Copyright © Nucleus Medical Media, Inc.

Be aware that in some cases, an open surgery may need to be used instead. During an open surgery, a larger incision will be made 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 medications
How Long Will It Take?
1-2 hours

Will It Hurt?
You will be given medication to 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.

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
  • Headaches, muscle aches, lightheadedness, or general ill feeling
  • Nausea and/or vomiting,
  • Constipation
  • 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
If you think you are having an emergency, call for emergency medical services right away.




RESOURCES:
National Uterine Fibroids Foundation

Women's Health.gov—US Department of Health and Human Services

CANADIAN RESOURCES:

Women's Health Matters

References:
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.

Uterine fibroid symptoms, diagnosis, and treatment. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patients/uterine-fibroids/. Accessed October 29, 2014.

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.

Last Reviewed October 2014



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