Type of Surgery
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Last updated: 11/24/2009
Usually, fibroids are buried in the outer wall of the uterus, and abdominal surgery is required. If they are on the inner wall of the uterus, uterine fibroids can be removed using hysteroscopy. If they are on a stalk (pedunculated) on the outer surface...
of the uterus, laparoscopy can be performed.
Removing fibroids through abdominal surgery is a more difficult and slightly more risky operation than a hysterectomy. This is because the uterus bleeds from the sites where the fibroids were removed, and it may be difficult or impossible to stop the bleeding. This surgery is usually performed under general anesthesia, although some patients may be given a spinal or epidural anesthesia.
The incision may be horizontal (the "bikini" incision) or a vertical incision from the navel downward. After separating the muscle layers underneath the skin, the surgeon makes an opening in the abdominal wall. Next, the surgeon makes an incision over each fibroid, grasping and pulling out each growth.
Every opening in the uterine wall is then stitched with sutures. The uterus must be meticulously repaired in order to eliminate potential sites of bleeding or infection. The surgeon then sutures the abdominal wall and muscle layers above it with absorbable stitches, and closes the skin with clips or non-absorbable stitches.
When appropriate, a laparoscopic myomectomy may be performed. In this procedure, the surgeon removes fibroids with the help of a viewing tube (laparoscope) inserted into the pelvic cavity through an incision in the navel. The fibroids are removed through a tiny incision under the navel that is much smaller than the 4–5 in (10–13 cm) opening required for a standard myomectomy.
If the fibroids are small and located on the inner surface of the uterus, they can be removed with a thin, telescope-like device called a hysteroscope. The hysteroscope is inserted into the vagina through the cervix and into the uterus. This procedure does not require any abdominal incision, so hospitalization is shorter.
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Uterine fibroids are a common cause of pain, abnormal bleeding and problems with fertility in women. Traditionally uterine fibroids are removed through the abdomen; however in some cases, skin incisions can be avoided if the uterine fibroids can be removed through the vagina, as discussed in this narrated animation. The removal of uterine fibroids is called a myomectomy.
Uterine fibroids can occur within the uterine cavity, in the mucous layer, or in the muscle (A). To remove them by myomectomy, an incision is made into the woman's lower abdomen (B). An incision is made in the uterus over the tumor (C), and it is removed (D). (Illustration by GGS Inc.)
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Other Information
Myomectomy refers to the surgical removal of uterine fibroids, also known as myomas. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.
The presence of a fibroid does not mean that it needs to be removed. Removal is called for when the fibroid causes pain, abnormal bleeding, or pressure.
A myomectomy can be performed in a number of ways, depending on the location and number of lesions and the experience of the surgeon. Typically a myomectomy is performed via a laparotomy, the uterus incised, and the lesion(s) removed. A fibroid that is located in a submucous position may be accessible to hysteroscopic removal. In some instances also laparoscopy can be utilized to extirpate fibroids.
Complications of the surgery include the possibility of significant blood loss leading to a blood transfusion, the risk of adhesion or scar formation around the uterus, and the possible need later to deliver via cesarean section. Development of new fibroids will be seen in 42-55% of patients undergoing a myomectomy .
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an obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system.
From: womenshealthchannel.com
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