Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach
CPT4 code
Name of the Procedure:
Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach.
Summary
A myomectomy is a surgical procedure to remove fibroid tumors from the uterus. This specific type involves the removal of up to four fibroid tumors, either located within the uterine muscle (intramural) or on the surface of the uterus, with a total weight no more than 250 grams. The procedure is performed through the vaginal route.
Purpose
A myomectomy is performed to address symptoms caused by uterine fibroids such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowel, and infertility. The goal is to relieve these symptoms while preserving the uterus, allowing for the possibility of future pregnancies.
Indications
- Heavy or prolonged menstrual bleeding.
- Pelvic pain or pressure.
- Frequent urination or constipation due to pressure.
- Infertility issues related to fibroids.
- Anemia from excessive menstrual bleeding.
- Rapid growth of fibroids.
Preparation
- Pre-procedure fasting, typically starting the night before surgery.
- Adjustments to current medications, especially blood thinners.
- Diagnostic imaging like ultrasound or MRI to locate and size fibroids.
- Blood tests to check overall health and readiness for surgery.
Procedure Description
- Anesthesia: Administered general or spinal anesthesia.
- Positioning: The patient is positioned in lithotomy position (on their back with legs elevated).
- Incision and Access: An incision is made in the vaginal wall to access the uterus.
- Excision: Fibroids are identified, excised, and removed. Any bleeding vessels are cauterized.
- Closure: The incision in the vaginal wall is sutured closed.
The procedure uses specialized surgical instruments and may involve laparoscopy if better visualization is needed.
Duration
The procedure typically takes 1 to 2 hours, depending on the number and size of fibroids.
Setting
The procedure is usually performed in a hospital or a specialized surgical center.
Personnel
- Surgeon (Gynecologist specialized in operative procedures)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Injury to adjacent organs (bladder, bowel)
- Scar tissue formation
- Recurrence of fibroids
- Potential need for blood transfusion
- Anesthesia-related risks
Benefits
- Relief from heavy menstrual bleeding and pelvic pain.
- Potential improvement in fertility.
Preservation of the uterus.
Benefits can often be realized immediately or within a few weeks post-surgery.
Recovery
- Hospital stay of 1 to 2 days.
- Pain management through oral or IV medications.
- Avoid heavy lifting and strenuous activities for at least 4 to 6 weeks.
- Follow-up appointments for monitoring recovery.
Alternatives
- Medication management (e.g., hormonal treatments).
- Non-invasive procedures like uterine artery embolization.
Other surgical options like hysterectomy.
Alternatives may pose different risks and benefits and may not be suitable for all patients.
Patient Experience
- During: Patient will not feel pain due to anesthesia.
- Post-procedure: Soreness, light bleeding, and mild discomfort.
Pain Management: Pain medications and comfort measures as needed.
Patient can expect a full recovery within several weeks and resume normal activities gradually.