Gynecology - Conventional gynecologic surgery

 

Myomectomy

Myomectomy is the surgical removal of uterine fibroid tumors while leaving the uterus in place. Uterine fibroids are growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 5-6 inches wide. As they grow, they can distort the inside as well as the outside of the uterus. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen. A woman may have only one fibroid or many of varying sizes. Whether fibroids will occur singly or in groups is hard to predict. They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years.

Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women. It is not clear what causes fibroids. Some research suggests that they develop from misplaced cells present in the body before birth. The female hormones estrogen and progesterone appear to be involved in their growth. Levels of these hormones can increase or decrease throughout a woman’s life. For instance, menopause causes a decrease in estrogen. Fibroids often shrink when a woman enters menopause. Hormonal drugs that contain estrogen, such as birth control pills, may cause fibroids to grow.

 

Fibroids may cause the following symptoms:

 

• Changes in menstruation
  • Longer, more frequent, or heavy menstrual periods
  • Menstrual pain (cramps)
  • Vaginal bleeding at times other than menstruation
  • Anemia (from blood loss)
    

 

• Pain
  • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
  • During sex

 

• Pressure
  • Difficulty urinating or frequent urination
  • Constipation, rectal pain, or difficult bowel movements
  • Abdominal cramps
    

 

• Enlarged uterus and abdomen
• Miscarriages
• Infertility
  

 

These symptoms also may be signs of other problems. Therefore, you should see your doctor if you have any of these symptoms. Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

Because a myomectomy allows a woman to keep her uterus, she may still be able to have children. If a woman does become pregnant after a myomectomy, the baby may need to be delivered by cesarean birth. Sometimes, though, a myomectomy causes internal scarring that can lead to infertility. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.

 

Myomectomy may be done in a number of ways:

• Laparotomy
• Laparoscopy
• Hysteroscopy

The method used depends on the location and size of the fibroids. In laparotomy, an incision (cut) is made in the abdomen. The fibroids are removed through the incision. In laparoscopy, a laparoscope is used to view the inside of the pelvis. Other tools are inserted through another small incision to remove the fibroids.

 

Hysteroscopy can be used to remove fibroids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. In most cases, an overnight stay in the hospital is not necessary.

 

Myomectomy has risks, including bleeding and infection. Hysteroscopy may cause other problems related to the use of fluid during the procedure. Your doctor can explain all of the risks to you.

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