Myomectomy: Removal
of the fibroid(s):
Myomectomy, with one exception, involves making
an incision into the uterus and removing one or more fibroids. If the
fibroid is on a stalk (pedunculated) it is not necessary to cut into the uterus
to cut the stalk. Unless the myoma is on the outside surface of the
uterus, the uterus is repaired with sutures. One of the major differences
in how a myomectomy is done involves the surgical approach to the uterus.
In a laparotomy an incision is made in the abdomen to reach the
uterus. The advantage of this is that large myomas can be quickly
removed. The surgeon is able to feel the uterus, which is helpful in
locating myomas that may be deep in the uterine wall. The ability to touch
the uterus facilitates repairing the uterus. The disadvantage of a
laparotomy is that it requires an abdominal incision. Most of my patients
who have this procedure spend two nights in the hospital, and return to work in
about four weeks.
Some myomas can also be removed by laparoscopy.
The laparoscope is a telescope placed in the abdomen through the belly
button. Other instruments are inserted through small individual incisions
in the abdominal wall. Many myomas can be removed by laparoscopy; this is
easier to do when the myomas are on a stalk or close to the surface. Once
the fibroids are removed they are cut into pieces by one of several instruments
designed for this purpose, and removed. The advantage of laparoscopic
myomectomy is that it is usually done as an outpatient, and allows faster
recovery than a laparotomy. One of the disadvantages is the extended time
needed to remove large fibroids from the abdomen, although newer instruments are
improving this. Since the surgeon cannot actually touch the uterus,
it may be more difficult to detect and remove smaller myomas. In addition,
if a woman plans pregnancy after her myomectomy, there is a question of whether
the uterus can be repaired through the laparoscope as well as it can be by
laparotomy.
Although many myomas can be removed
through the laparoscope, the decision of which myomas should be removed
laparoscopically and which by laparotomy depends on many factors. A woman
should discuss the advantages, disadvantages, and risks of each type of surgery
with a surgeon who is experienced in all treatment methods.
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15195 National Avenue, Suite 201; Los Gatos, CA 95032
Telephone : 408 358-2788 ; FAX : 408 356-5526
