Myomectomy
Myomectomy is a surgical procedure aimed at removing symptomatic fibroids, which are benign tumors located on the uterine wall. This procedure is commonly preferred over a hysterectomy when patients wish to preserve their ability to bear children, provided there are no signs of uterine malignancy. Myomectomy can be performed through various approaches, including abdominal, laparoscopic, vaginal, or hysteroscopic methods, with the choice of technique depending on the size and location of the fibroids, as well as the surgeon's expertise.
The abdominal myomectomy is often the most utilized technique, involving a larger incision and general anesthesia. The procedure focuses on identifying and excising fibroids while minimizing damage to the surrounding tissue to maintain future fertility. Other methods, such as laparoscopic and hysteroscopic approaches, offer less invasive options, aiming to reduce recovery time and complications.
The primary goal of myomectomy is to alleviate symptoms caused by the fibroids, which may include pelvic pain, excessive bleeding, and urinary issues. While the short-term risks are manageable, potential long-term complications can arise, including uterine rupture in subsequent pregnancies and the possibility of fibroid recurrence. Each technique carries its own set of risks, but hysteroscopic myomectomies generally present fewer complications due to their minimally invasive nature.
Subject Terms
Myomectomy
Anatomy or system affected: Reproductive system, uterus
Definition: The removal of a uterine myoma, also known as a fibroid or leiomyoma
Indications and Procedures
The most common indication for a myomectomy is the need to remove a symptomatic fibroid. A fibroid is a benign tumor on the wall of the uterus. In many cases, these fibroids are large (greater than eight centimeters). A myomectomy is chosen over a hysterectomy (removal of the uterus) if the patient desires future childbearing and if there is no evidence of malignancy of the uterus. A myomectomy can be performed using abdominal, laparoscopic, vaginal, or hysteroscopic approaches. The choice of approach depends on the location and size of the fibroids, as well as on the experience of the surgeon.
The most common type is abdominal myomectomy. This procedure is performed in the operating room with the patient under general anesthesia. The abdomen is incised, and entry into the pelvic cavity is obtained. The uterus is then identified and inspected for fibroids. Some surgeons apply a tourniquet to the uterine arteries for hemostasis. A vasoconstrictive agent is injected into the myometrium surrounding the fibroid to minimize blood loss. The myometrium over the fibroid is then incised, and the fibroid is dissected out. Finally, the myometrial defect is closed with a suture to stop blood flow. In patients desiring fertility, care is taken to minimize entry into the endometrial cavity, as the procedure may increase the risk of uterine rupture with pregnancy.
In laparoscopic and vaginal myomectomies, access to the fibroids is obtained using endoscopic instruments and through an incision in the vagina, respectively. In hysteroscopic myomectomies, access to fibroids in the endometrial cavity is obtained using a hysteroscope inserted through the cervical canal. The hysteroscope holds an instrument that shaves away fibroids in the endometrial cavity.
Uses and Complications
The primary use of myomectomy is the relief of symptoms caused by fibroids. These symptoms can be any of the following: pressure sensation, pelvic pain, dyspareunia (painful intercourse), menorrhagia (excessive menstruation), dysmenorrhea (painful menstruation), urinary urgency or frequency, urinary incontinence, and constipation.
The short-term risks of abdominal myomectomies are the same as those for most pelvic surgeries. These risks are small but include infection, damage to internal organs such as the bowel or bladder, blood loss requiring transfusion, and complications from anesthesia. Long-term consequences include an increased risk of uterine rupture with future pregnancy, the recurrence of fibroid growth, and pelvic adhesion (scar tissue) formation. Laparoscopic myomectomies are less invasive than abdominal myomectomies, but the same short-term and long-term risks are present. Hysteroscopic myomectomies carry fewer risks than abdominal procedures since no incision is made on the abdomen and there is no entry into the pelvic cavity, but the risks unique to hysteroscopy exist, such as uterine perforation and fluid overload.
Bibliography
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