myomectomy


Also found in: Dictionary, Wikipedia.

Myomectomy

 

Definition

Myomectomy is the removal of fibroids (noncancerous tumors) from the wall of the uterus. Myomectomy is the preferred treatment for symptomatic fibroids in women who want to keep their uterus. Larger fibroids must be removed with an abdominal incision, but small fibroids can be taken out using laparoscopy or hysteroscopy.

Purpose

A myomectomy can remove uterine fibroids that are causing symptoms. It is an alternative to surgical removal of the whole uterus (hysterectomy). The procedure can relieve fibroid-induced menstrual symptoms that have not responded to medication. Myomectomy also may be an effective treatment for infertility caused by the presence of fibroids.

Precautions

There is a risk that removal of the fibroids may lead to such severe bleeding that the uterus itself will have to be removed. Because of the risk of blood loss during a myomectomy, patients may want to consider banking their own blood before surgery.

Description

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, 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. Then, the surgeon sutures the abdominal wall and muscle layers above it with absorbable stitches, and closes the skin with clips or nonabsorbable 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 or 5 inch 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.

Preparation

Surgeons often recommend hormone treatment with a drug called leuprolide (Lupron) two to six months before surgery in order to shrink the fibroids. This makes the fibroids easier to remove. In addition, Lupron stops menstruation, so women who are anemic have an opportunity to build up their blood count. While the drug treatment may reduce the risk of excess blood loss during surgery, there is a small risk that temporarily-smaller fibroids might be missed during myomectomy, only to enlarge later after the surgery is completed.

Aftercare

Patients may need four to six weeks of recovery following a standard myomectomy before they can return to normal activities. Women who have had laparoscopic or hysteroscopic myomectomies, however, can leave the hospital the day after surgery and usually recovery completely within two to three days to one to three weeks.

Risks

The risks of a myomectomy performed by a skilled surgeon are about the same as hysterectomy (one of the most common and safest surgeries). Removing multiple fibroids is more difficult and slightly more risky.
Possible complications include:
  • Infection.
  • Blood loss.
  • The wall of the uterus may be weakened if the removal of a large fibroid leaves a wound that extends the complete thickness of the wall. Special precautions may be needed in future pregnancies. For example, the delivery may need to be performed surgically (Caesarean section).
  • Adverse reactions to anesthesia.
  • Internal scarring (and possible infertility).

Key terms

Epidural anesthesia — A method of pain relief for surgery in which local anesthetic is injected into the epidural space in the middle and lower back.
Since fibroids tend to appear and grow as a woman ages (until menopause), it is possible that new fibroids will appear after myomectomy.

Resources

Other

Toaff, Michael E. "Myomectomy." Alternatives to Hysterectomy Page. 〈http://www.netreach.net/∼hysterectomyedu/myomecto.htm〉.

myomectomy

 [mi″o-mek´to-me]
1. surgical excision of a myoma.
uterine myomectomy surgical removal of a uterine myoma (leiomyoma); called also fibroidectomy and fibromyomectomy.

my·o·mec·to·my

(mī'ō-mek'tō-mē),
Operative removal of a myoma, specifically of a uterine myoma.
[myoma + G. ektomē, excision]

myomectomy

(mī′ə-mĕk′tə-mē)
n.
Surgical removal of a myoma, especially of a uterine myoma.

myomectomy

The isolated excision of a uterine leiomyoma—popularly, fibroma without hysterectomy.

myomectomy

Gynecology Excision of a uterine leiomyoma–popularly, fibroma without hysterectomy. See Leiomyoma.

my·o·mec·to·my

, myomatectomy (mī'ō-mek'tŏ-mē, -mă-tektŏ-mē)
Operative removal of a myoma, specifically of a uterine myoma.
[myoma + G. ektomē, excision]
References in periodicals archive ?
UFE and myomectomy are procedures with similar efficacy and durability for treating fibroids, but the UFE has fewer complications and shorter hospital stays," said Jemianne Bautista-Jia, MD, radiology resident at Kaiser Permanente and lead author of the study.
When medical management, such as combination oral contraceptive pills, fails in patients with AUB and/or bulk predominant symptoms or patients present with compromised fertility, the only option for conservative surgical management is a myomectomy. (4)
African American women chose similar or greater numbers of each type of myomectomy and uterine embolization as white women chose.
It was planned to resort for abdominal myomectomy which was successfully performed on 10 December 2016.
She said hysterectomy may be indicated if complications arise during myomectomy if no other treatment works for you or in older women who do not desire fertility.
A myomectomy was performed laparoscopically, and the patient's abdomen was washed out.
Here, we present a case of a successful pregnancy following myomectomy accompanied with abdominal radical trachelectomy for an infertile woman with early-stage cervical cancer.
During the hysteroscopic myomectomy, a 7-8 mm sized rupture near the fundus was observed (Figure 1).
According to WebMD, "Myomectomy is the surgical removal of fibroids from the uterus.
Fertility preserving surgical options for uterine fibroids includes robotic-assisted, laparoscopic, and abdominal (open) myomectomy. Open surgery via laparotomy was the original surgical technique described; however it results in a larger incision, more postoperative pain, and longer hospitalization than minimally invasive techniques [2-6].
Hysteroscopic myomectomy is usually performed with a progressive slicing of the intracavitary portion of the SM, a subsequent "cold loop" pushing of the intramural part (to preserve the pseudocapsule), and, finally, a slicing resection of it [1-3].
Types of surgery included hysterectomy, myomectomy, endometrial and ovarian cancer), midurethral sling placement, and pelvic reconstruction.