Myomectomy or removal of the fibroids

by Wilson Moore Writter

Myomectomy is a surgical procedure in which one or more fibroids are removed from the uterus.

Myomectomy via laparotomy

Myomectomy is the surgical removal of one or more fibroids. The uterus itself is spared, so a pregnancy remains possible. Traditionally, myomectomy is performed via laparotomy or abdominal fibroid surgery. A small - usually horizontal - cut is made in the abdomen (such as for a cesarean section). The surgeon can opt for this procedure if there are many fibroids, if they are large or if they grow deeply.

Myomectomy via laparoscopy

If the fibroids are not too large (the maximum diameter depends on the experience of the gynecologist with laparoscopic operations) and if there are no more than four fibroids, a myomectomy can be performed via laparoscopy. The surgeon first makes small holes around the navel and above the pubis (the pubic bone). Through this way, he brings in instruments and he takes the fibroids out in small pieces.

Myomectomy via hysteroscopy

With this technique, the fibroid is removed vaginally. Only submucosal fibroids can be removed in this way. The surgeon performs an endoscopy of the uterine cavity via the vagina ( hysteroscopy ). Through the scabbard, he brings an endoscope (a long tube that is equipped with a camera) into the womb. With a metal needle of a few millimeters that is heated with electricity, the surgeon cuts the fibromic tissue into small pieces and then takes it out of the uterine cavity. It is therefore not cut into the body and therefore no need to be attached.

Hysterectomy

The uterus is removed in case of a hysterectomy. It is the only definitive solution for fibroids because after that no new ones can form. This operation is only applied in the worst cases where the other therapeutic options cannot or can not be used in patients who no longer want children. The hysterectomy is partial (or subtotal: the cervix is spared) or complete. It can be executed in three ways:

through the abdomen (cut in the lower abdomen),
through the vagina,
via laparoscopy (multiple small slices in the zone above the pubis).

Usually, the patient can choose whether or not to keep her ovaries. The decision depends on the age, whether or not the patient is already in menopause and whether ovarian cancer is present in the family.