Myomectomy , sometimes also fibroidectomy , refers to surgical removal of a uterine leiomyoma, also known as fibroids. In contrast to uterine hysterectomy is maintained and women maintain their reproductive potential.
Video Uterine myomectomy
Indication
The presence of fibroids does not mean that it needs to be removed. Removal is necessary when fibroids cause pain or pressure, abnormal bleeding, or interfere with reproduction. The required fibroids to be removed are usually large, or growing in certain locations such as bulging into the endometrial cavity causing significant cavity distortion.
Patients have many options in the management of uterine fibroids, including: observation, medical therapy (such as GnRH agonists), hysterectomy, uterine artery embolization, and high intensity focused ultrasound ablation. Despite these options, the selected surgical removal approach of fibroids remains an important option for women who want or need to maintain the uterus.
Maps Uterine myomectomy
Procedures
Myomectomy may be performed in several ways, depending on the location and number of lesions and the experience and preferences of the surgeon. Neither general or spinal anesthesia is given.
Laparotomy
Traditionally, myomectomy is performed through laparotomy with a full abdominal incision, either vertically or horizontally. After the peritoneal cavity is opened, the uterus is sliced, and the lesion is removed. An open approach is often preferred for larger lesions. One or more incisions can be set into the uterine muscle and repaired after fibroids are removed. Recovery after surgery takes six to eight weeks.
Laparoscopy
Using a laparoscopic approach the uterus is visualized and its fibroids are found and removed. Studies have shown that laparoscopic myomectomy leads to lower morbidity and faster recovery than laparotomic myomectomy. Like hysteroscopic myomectomy, laparoscopic myomectomy is generally not used in very large fibroids. A laparoscopic myomectomy study conducted between January 1990 and October 1998 examined 106 cases of laparoscopic myomectomy, in which intramural or subserous fibroids and ranged from 3 to 10 cm.
Hysteroscopy
Fibroids located in the submucosal position (ie, protruding into the endometrial cavity) may be accessible for hysteroscopic disappearance. This may apply mainly to smaller lesions as demonstrated by large studies that collect the results of 235 patients with submucosal myomas treated with hysteroscopic myomectomy; none of these cases are fibroids greater than 5 cm. However, larger lesions have also been treated with hysteroscopy. Recovery after hysteroscopic surgery is only a few days.
Complications and risks
The surgical complications include the possibility of significant blood loss leading to blood transfusions, the risk of adhesion or scar formation around the uterus or in the cavity, and possibly the need for later delivery by caesarean section.
It is impossible to remove all lesions, and surgery will not prevent new lesions from growing. Development of new fibroids will be seen in 42-55% of patients undergoing myomectomy.
It is well known that myomectomy surgery is associated with a higher risk of uterine rupture in subsequent pregnancies. Thus, women who have had myomectomy (with the exception of removal of small submucous myomas via hysteroscopy, or the removal of large-stemmed myomas) should receive a caesarean section to avoid the risk of uterine rupture which is generally fatal to the fetus.
To reduce bleeding during myomectomy, the use of misoprostol in the vagina and injection of vasopressin into the uterine muscle are equally effective. There is little evidence to support the use of chemical dissection (such as mesna), dinoprostone vaginal insertion, gelatin-thrombin matrix, tranexamic acid, vitamin C infusion, infiltration of bupivacaine and epinephrine mixtures into uterine muscle, or use of fibrin patch sealant.
Myomectomy during pregnancy
Leiomyomata tend to grow during pregnancy but only the large ones causing distortion of the endometrial cavity can interfere with a growing pregnancy directly. Generally, surgeons tend to stay away from surgical interventions during pregnancy because of the risk of bleeding and concerns that pregnancy may be impaired. Also, after pregnancy, myomas tend to shrink naturally. However, in certain cases, a myomectomy may be necessary during pregnancy, or also during a caesarean section to gain access to the baby.
References
http://www.merciafibroidclinic.com/Fibroids-Treatments/Myomectomy-Laparoscopic/myomectomy-laparoscopic.html
Source of the article : Wikipedia
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