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Overview

Myomectomy: Procedure, Recovery, Cost, Risk & Complication

What is Myomectomy?

Myomectomy refers to a surgical procedure for removing leiomyomas (uterine fibroids), which are non-cancerous growths that appears in the uterus. Generally, these tend to occur during the childbearing years, but it is possible for them to occur at any age.

In the process of myomectomy, the doctor will take out the fibroids and try to reconstruct the uterus. Unlike hysterectomy, this process removes only the fibroids, keeping the uterus intact. It is the preferred fibroid treatment in case of women who wish to get pregnant. It can also relieve symptoms related to fibroids, such as heavy bleeding during menstruation and pelvic pressure.

Indication

A patient may have to undergo myomectomy in the following circumstances:

  • If the fibroids are resulting in symptoms that are bothersome or interfering with your regular normal activities
  • You are planning for pregnancy and the uterine fibroids may be interfering with your fertility
  • For improving the chances of pregnancy before an IVF (in-vitro fertilization) treatment
  • If you are anaemic, or suffering from pain that does not seem to improve with medications

What Procedure is followed :

Pre Procedure

The following pre-procedure guidelines need to be followed before undergoing a myomectomy:

  • Discuss with your doctor about the procedure and get an idea about how it will be conducted. You can also ask about the anaesthesia that you will be administered; whether general or spinal.
  • Inform your doctor about all the medications that you need to take on a regular basis. You may have to stop taking some medicines a week prior to the surgery. Consult your doctor about the same and follow the instructions.
  • You will have to stop eating or drinking anything a few hours before the surgery. In case you have to take any medicines during that time, have it with a minimum sip of water.

During Procedure

Depending on the number, location and size of the fibroids, any of the following ways of myomectomy may be approached by the surgeon:

  • Abdominal myomectomy – In this procedure, the surgeon makes an open incision in the abdomen to get access to the uterus and then removes the fibroids. It can be a horizontal incision along the bikini line or a vertical incision.
  • Laparoscopic myomectomy – A small incision is made in or near the navel, and a laparoscope is inserted in the abdomen. The surgeon performs the operation by inserting the surgical instruments through the other small incisions that are made in the abdominal wall.
  • Hysteroscopic myomectomy – In this process, a lighted viewing instrument is inserted in the uterus through the vagina. A sterile solution is then passed on to the uterus. The surgeon will shave out the pieces of the fibroid that will be washed out along with the liquid that was previously inserted.

Post Procedure

You may only have to stay overnight at the hospital and then get discharged after undergoing a myomectomy. You will be given oral medications for relieving you from the pain. Consult with your doctor if you experience any side effects of the medication. Also, follow the restrictions that are suggested by the doctor regarding your diet and activities. It is normal to experience vaginal staining or spotting, ranging from a few days to a few weeks, depending on the procedure that you have undergone. The pain medicines may make you feel drowsy or dizzy, so be careful when you are getting up from a sitting or sleeping position.

Risk & Complication

Undergoing a myomectomy may have the following complications:

  • Loss of excessive blood. Women who are suffering from anaemia due to excessive bleeding during menstruation are at a higher risk of developing problems in case of blood loss during the procedure
  • Incisions that are made in the uterus for removing the fibroids may lead to a formation of a band of scar tissues. They may tangle the nearby structures of the uterus, blocking the fallopian tube.
  • In case the bleeding cannot be stopped, the uterus may have to be removed completely.
  • In rare conditions, if a cancerous tumor is mistaken for a fibroid and removed by breaking them in small pieces during a myomectomy, it can lead to the spread of cancer in other parts.

More Info

You may have to undergo a pelvic exam and ultrasound after the surgery so that the doctor can examine the status of your condition. Removing the submucosal fibroids improves your chances of fertility and pregnancy. Wait for 3 months after undergoing myomectomy before trying for conception, so that the uterus gets adequate time for healing. You may do simple leg movements and stretches to prevent the formation of blood clots, but ensure that you do not do any intense cardiovascular exercises unless you have the approval of your doctor. After a period of 4-6 weeks, you can resume your exercise routine. Make sure to keep an eye in the area of incision, any type of redness or drainage must be reported to the doctor at once.

The price of myomectomy could be approximately Rs. 2,00,000 – Rs. 3,00,000.

Popular Health Tips

Myomectomy - 3 Surgical Methods

MBBS, DGO, DNB (Obstetrics and Gynecology), FMAS, FAM
Gynaecologist, Delhi
Myomectomy - 3 Surgical Methods

Fibroids are non-cancerous growth that develop in the uterus in varying sizes. Fibroids do not usually show symptoms, but if they are large they may cause severe pain in the abdomen, heavy menstrual bleeding, bloating, infertility or complications during pregnancy. Several factors may lead to the formation of fibroids, including hormones, family history, and pregnancy.

What is myomectomy?
Myomectomy is the surgical procedure which is used for removing fibroids from the uterus. It is a safe method that allows women to become pregnant in future. Gonadotropin-releasing hormone analogue therapy, performed before myomectomy helps in lowering the estrogen level and also controls anemia by stopping uterine bleeding. The different surgical methods for myomectomy include:

  • Hysteroscopy, involving the insertion of a lighted viewing instrument into the uterus
  • Laparoscopy, involving the insertion of a lighted viewing instrument and one or more incisions in the abdomen
  • Laparotomy, involving a larger incision made in the abdomen

Why is the surgery performed?
Myomectomy treats fibroids while preserving the uterus. It is a viable option for those who have:

  • Anemia which cannot be controlled with medicines
  • Pain which cannot be tackled with medicines
  • A fibroid that can cause infertility or increases the risk of miscarriages

How well does it work?

  • Pregnancy: myomectomy is the only treatment for treating fibroids that improve your chances of having a baby. The method is effective for treating submucosal fibroid. A cesarean section is required for delivery after performing a myomectomy.
  • Recurrence: recurrence of fibroids after myomectomy is really low. It is possible in rare cases, depending on what the original fibroid problem was. Large and numerous fibroids have a greater risk of recurrence. If you wish to discuss about any specific problem, you can consult a Gynaecologist.
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Popular Questions & Answers

Hello, I have got myomectomy done 20 days back but still I am having issue with the lower abdomen pain. My pus cells in urine 5 to 6 and epithelial cells are 10 to 15. Is it any infection or it is normal? Please guide. Thanks.

MD - Consultant Physician, Doctor of Medicine, MD
General Physician, Ahmedabad
Suggests infection urinary. Take vit c 500 mg daily to acidify urine. Take antibiotic under advice physician consult me with urine culture and ast of urine immediate.
1 person found this helpful

I am 38 years old have a boy of 10 years. Want to have second issue but unfortunately had miscarriage this feb before completion of 3 months. Previously in 2015 I had myoma operation in uterus. I am afraid wht to do.

Diploma in Obstetrics & Gynaecology, MBBS
General Physician, Delhi
Get tubes tested by hsg test just after periods and this test is diagnostic and therapeutic by telling you about the blocks in tubes and clearing tiny blocks if present due to mucous collected in tubes.

Table of Content

What is Myomectomy?

Indication

What Procedure is followed :

Risk & Complication

More Info

Play video
Laparoscopic Surgery
What is laparoscopic surgery?

Laparoscopic surgery is basically a keyhole surgery whereby instead of opening up the entire hand inside the abdomen to operate what we are preferring to do it is to put a fiber optic cable inside through a small puncture. The fiber optic cable allows us to look at the internal organs on a huge screen of 14 inches screen or 32 inches screen inside the operation theatre. We are using parallel smaller punctures with very small instruments to be able to operate without having to open up the tummy. And when we are looking at the magnified image of the screen there is a comfort level in the surgery. The surgery goes much more delicately, much more finely and thereby we are able to achieve the end result without much of tissue trauma without much of bleeding. And if there is no bleeding, if there is no tissue trauma then definitely the recovery for the patient is fantastic. As a latest advancement the technology has improved significantly and we are now able to operate in 3D. So 3D laparoscopy provide us the perfect depth perception that required to understand the tissues. So if any repair is done like in case of the myomectomy I removed the fibroids and I repaired the uterus the 3D depth perception allows me to have a proper visualization of the tissues so have the repair to be done very finely. The end result allows the patient to heal quickly, fast and without any further complications or problems arising. In fact advantages of 3D is so significant that we are able to do the procedure as day care procedure whereby the patient s get admitted in the morning get the surgery done which is usually a 45minutes to one hour procedure and send the patients home in the evening. Size of the fibroids size of the uterus for a myomectomy where this fibroid removal has become irrelevant because we have small cutters moderators whereby the entire tissue can be removed from a one centimetre puncture same is for the hysterectomy. If I am doing a laparoscopic hysterectomy or a 3D laparoscopic hysterectomy the number of surgeries which have been done previously multiple Sicilians which have done previously or whether the fibroid size is too large have stopped becoming relevant there is no problem in any of these situations and the end result remain the same for the patients.

Thank you!
Play video
Infertility Treatment
Treatment of Infertility by Laparoscopy and Hysteroscopy

I am Dr. Vishakha Munjal. I am a laparoscopy surgeon and infertility specialist. Today, I am going to talk about the role of laparoscopy and hysteroscopy in treating infertility.

Today, infertility has almost become an epidemic. This is because of multiple reasons like late marriages, late planning of pregnancy, various diseases like tuberculosis and pelvic infections which affect the fallopian tubes and cause their blockages. Then there is a certain disease like Endometriosis and fibroids which are at times the reason for infertility. These days lifestyle changes and an increase in stress level is also one of the reasons for ovulatory dysfunction and decreased sperm count. Couples facing infertility should consult an experienced gynecologist to understand the reason for infertility and how best it can be solved. Laparoscopic and Hysteroscopic surgeries can greatly help in diagnosing as well as many factors of infertility, thus, helping a woman to conceive naturally. Also, certain conditions like fibroids, endometriosis, and tubal factors need to be treated prior to IVF to increase the success rate of IVF else the woman will undergo multiple cycles of IVF and will get no results. So, it is very important to treat disease prior undergoing IVF.

The major Fertility Enhancing Surgery is Fibroid Removal, which is also called Myomectomy. Almost, any size of the fibroid can be taken care of laparoscopically. Compared to an open surgery, Laparoscopic Myomectomy has lesser blood loss and leads to lesser addition formation. It is also less painful for the patients. Patients can return back to work more quickly and they can plan for pregnancy also more quickly. Then, there is Endometriosis which is a chronic painful condition which causes severe pain during periods and during sex along with fertility. It is one of the major reasons for infertility in today s age. It is also associated with cyst formation at times which is called the chocolate cyst. Laparoscopy is a gold standard for treating Endometriosis. After Endometriosis, a woman gets not only relieve her pain but also she is able to conceive quickly. Then there are variances which are a hindrance for conception. Any size of the ovarian cyst can be treated laparoscopically.

First of all, get a histopathological diagnosis to rule out any malignancy in the cist as well as we remove the hindrance which is coming in the way of conception. Then, talking about tubal factors, tubal blockage at any level can be treated laparoscopically and if the blockage is at the starting of the fallopian tube then there are very fine cannulas available along with guide wires available which we used to cannulate the fallopian tubes and this can be done very effectively and it increases the chances of conception naturally. Now, let me talk about hysteroscopy. Well, hysteroscopy is a small telescope which is passed into the uterine cavity to see the cavity from inside for any pathology and to see the opening of the fallopian tube. Certain factors like presence of a fibroid, a polyp, a polyp is a sort of growth inside the uterine cavity, a septum which is like a wall causing a partition inside the uterine cavity. They all can be removed hysteroscopic ally, once this thing is removed hysteroscopic ally, the chances of the conception of a woman in creases greatly. All in all laparoscopy and hysteroscopy are a boon for infertility management. Laparoscopy is technically as much superior procedure than an open surgery. Since it is done through small punctures it is cosmetically very appealing, it causes less pain, less blood loss, less hospital stay, early recovery and early return to work for a patient.

If you wish to contact me for any laparoscopic enhancing surgery or infertility related problems, you can contact me at MediClinic, E16 Lajpat Nagar 3. Thank you.
Play video
Know More About Fibroids
Hello everybody. I'm Dr Pulkit Nandwani. I'm a consultant gynaecologist and laparoscopic surgeon here at Saroj Medical Institute Rohini. Today, I would like to share some information with you about fibroids.

Fibroids are becoming increasingly common these days. They usually occur in the age group of 30 to 40 years of women but can occur at any age group usually at the age group of 30 to 40years.

Now what are fibroids?

Fibroids are usually noncancerous just an overgrowth of the muscle tissue of the uterus. Fibroids are also called myomas or leiomyomas. Now these fibroids can be located anywhere in the uterus. They can be either in the muscle tissue of the uterus or even in the ovaries or from a stem hanging inside the uterus or out of the wall of the uterus by hanging by a stem. The size and location number of fibroids vary a lot and according to them the symptoms depend.

Now what are the symptoms of fibroids?

The symptoms of fibroids depend on where the situation where the fibroid is located, how big it is and how many numbers of fibroids are located. The symptoms can be they usually cause the change in menstruation. The patient usually experiences heavy bleeding with painful cramping and now instead of monthly bleeds. The bleed may come at irregular intervals and at least twice or thrice in a month. There can be pain during bleeding. Other than the painful bleeding, the fibroid can also result in various symptoms. Because of the size and the weight of the fibroid, it might press on the urinary bladder and the patient might experience frequency of urination even pain during urination. Same if it's at the back of the uterus, it might press on the anus and cause painful deification obtained while passing motions. Because of the heavy bleeding patient might land up with low hemoglobin and having anemia and generalized symptoms of anemia like the fatigue, the weakness, loss of strength, loss of stamina, all these are the symptoms of fibroids. Just a pain in the lower abdomen can also be the manifestation of fibroid.

Fibroid can also cause infertility. Patient might find difficulty in conceiving or there are chances if the patient conceives if the fibroid is located inside the lining of the uterus it might cause increased chances of miscarriages. There might be abortions then but the good thing is that fibroids rarely cause cancer. It might twist on itself, cause severe pain and but it rarely causes cancer and grows over a period of time. It slowly grows over a period of time, sudden growth is a matter of danger sign.

Now, what are the treatments available for fibroid?

Fibroid if it is asymptomatic the patient is comfortable it was just the routine diagnosis, need not require any treatment at all but usually fibroids cause bleeding problems. So the most common treatment that we employ is starting the patient on medical treatment, a number of hormonal pills come which regulate the hormones inside the body of the uterus and limits the blood flow of the patient and the patient remains comfortable. If medical treatment is either not successful or by the location of the fibroid we already know that medical treatment will not work as in case if the fibroid is coming inside the lining of the uterus. In those cases the fibroid has to be removed surgically for the fibroid is usually done. If it is coming inside the lining of the uterus even if it is very small or a big fibroid is obstructing, the uterus lining causing pressure symptoms. In that case surgery has to be done. Now for surgery also there are two to three types of surgery which can be done.

If so patient is young, she has to conceive again and family is not completed, we try to remove only the fibroid. It is known as myomectomy.
If the patient is elderly age family is completed, it caues a lot of problproblemshere are multiple fibroids, in that case, the modality of treatment is a one-stop treatment in which we prefer to remove the whole uterus in which case it is known as hysterectomy.
Regularly total laparoscopic hysterectomy fully by laparoscopy is done routinely at the hospital at Saroj Medical Institute for fibroids.
So this is much for fibroid for today. If you have any query you can contact me at lybrate. I am Dr. Pulkit Nandwani or you can even take a consultation appointment at Saroj Medical Institute Rohini, Delhi.

Thank you.
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