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Myomectomy Surgery for Fibroids
Myometcomy is a type of surgery to treat fibroids, the round growths in the uterus that are usually benign (non-cancerous). Fibroids can range in size from pea-sized to melon-sized, and the growths are classified by their location, with four primary types:
- Subserosal fibroids develop in the outer portion of the uterus and continue to grow outward
- Intramural fibroids develop within the uterine wall
- Submucosal fibroids develop just under the lining of the uterine cavity
- Pedunculated fibroids grow on a stalk and develop either in the uterus or outside the uterus
The size, location and number of fibroids a woman has — as well as her desire for reproductive function — determine what kind of treatment she needs. For women who have fibroid symptoms and want to retain their ability to have children, myomectomy may be a good option for treatment. Myomectomy removes fibroids while preserving the uterus.
Myomectomy can performed several different ways, including abdominal or "open" myomectomy, laparoscopic myomectomy, hysteroscopic myomectomy and robotic myomectomy.
An open myomectomy is a major surgical procedure in which a surgeon makes an incision through the skin of the lower abdomen to remove fibroids from the wall of the uterus. The full recovery time can be anywhere from four to six weeks, and the doctor may recommend that future pregnancies be delivered via cesarean section.
Open myomectomy is typically used for complex cases in which fibroids are large, deeply embedded in the uterus or when there are many fibroids.
A laparoscopic myomectomy is a minimally invasive procedure, which is usually performed as an outpatient surgery. With laparoscopic surgery, the surgeon uses a slender, lighted telesscope (laparoscope)j inserted through the navel to view the pelvic and abdominal organs. Long instruments are inserted through other incisions are used to remove the fibroids.
During laparoscopic surgery, the surgeon does not look into the abdomen directly through a large incision; instead, he or she is performing the surgery while looking at a large video monitor. The incisions are smaller with laparoscopic surgery; therefore, recovery time is faster; however, the surgery is generally used for less complex cases of fibroids.
Submucosal fibroids, those that develop just under the lining of the uterine cavity, may be removed with a hysteroscopic myomectomy, which is an outpatient procedure.
With hysteroscopic myomectomy, the doctor uses a narrow fiber optic telescope inserted into the uterus through the cervix to look for fibroids and uses a resectoscope — a hysteroscope fitted with a wire loop that uses high-frequency electrical current to cut tissue — to remove them.
Robotic myomectomy is a minimally invasive option for more complex fibroids. Robotic assisted surgery allows the surgeon to have better visualization of fibroids and surrounding tissue than with laparoscopic surgery, as well as an improved ability to suture the uterus.
With robotic surgery, the surgeon's hands control the instruments in the robot's arms while the surgeon sits at a console and performs the procedure using an enhanced, three-dimensional image. Four quarter-length incisions are made and ports inserted for the robot's camera and arms, and the fibroid is removed from the uterine tissue, cut into smaller pieces inside the patients abdomen and removed through the ports.