58146 Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach

Name of the Procedure:

Myomectomy (Excision of fibroid tumor(s) of the uterus, 5 or more intramural myomas and/or intramural myomas with a total weight greater than 250 g, abdominal approach)

Summary

A myomectomy is a surgical procedure to remove fibroid tumors (non-cancerous growths) from the uterus. When the procedure involves removing 5 or more intramural myomas (fibroids located within the muscular wall of the uterus) or fibroids with a total weight greater than 250 grams, an abdominal approach is used.

Purpose

Medical Condition:

• Uterine fibroids causing symptoms or complications.
  ##### Goals/Expected Outcomes:
• Relief from symptoms like heavy menstrual bleeding, pelvic pain, and pressure.
• Preservation of the uterus and potential improvement in fertility.

Indications

Symptoms/Conditions:

• Heavy menstrual bleeding.
• Pelvic pain or pressure.
• Anemia due to excessive blood loss.
• Infertility or recurrent miscarriages.
  ##### Patient Criteria:
• Symptomatic fibroids not amenable to less invasive treatments.
• Desire to preserve the uterus and maintain fertility potential.

Preparation

Pre-procedure Instructions:

• Fasting for a specific period (usually 8-12 hours before surgery).
• Adjusting or stopping certain medications as advised by your doctor.
• Discussing all medications, allergies, and medical history with the surgeon.
  ##### Diagnostic Tests:
• Pelvic ultrasound.
• MRI or CT scan to assess the size, number, and location of fibroids.
• Blood tests to evaluate overall health and readiness for surgery.

Procedure Description

Steps:

1. Anesthesia administration (typically general anesthesia).
2. A horizontal or vertical abdominal incision is made.
3. The uterus is accessed, and fibroids are carefully excised one by one.
4. The uterine muscle is repaired, and the incision is closed with sutures. ##### Tools/Equipment:
   • Surgical scalpel, scissors, and specialized instruments for fibroid removal.

   • Laparoscopic tools may sometimes be used in certain cases.

     Anesthesia:

   • General anesthesia is typically used to ensure the patient is asleep and pain-free during the procedure.

Duration

The procedure typically takes 1-3 hours, depending on the number and size of fibroids.

Setting

The procedure is performed in a hospital or surgical center equipped for major abdominal surgery.

Personnel

• Surgeon (often a specialist in gynecology).
• Anesthesiologist.
• Surgical nurses.
• Support staff (e.g., surgical technicians).

Risks and Complications

Common Risks:

• Infection.
• Bleeding.
• Scar tissue formation.

Rare Complications:

• Damage to surrounding organs (e.g., bladder, intestines).
• Blood clots.
• Complications related to anesthesia.

Benefits

• Relief from symptoms such as heavy bleeding and pelvic pain.
• Potential improvement in fertility.
• Preservation of the uterus.

Recovery

Post-procedure Care:

• Hospital stay for 1-2 days for monitoring.
• Pain management with medications.
• Avoiding heavy lifting and strenuous activities for 4-6 weeks.
• Follow-up appointments to monitor healing and uterine function.

Expected Recovery Time:

• Full recovery typically takes 4-6 weeks.

Alternatives

Treatment Options:

• Medications to manage symptoms (e.g., hormonal treatments).
• Uterine artery embolization (UAE).
• Hysterectomy (complete removal of the uterus).

Pros and Cons:

• Medications: Less invasive but may not be effective for large fibroids.
• UAE: Minimally invasive but may not be suitable for very large or numerous fibroids.
• Hysterectomy: Definitive treatment but results in loss of fertility and uterus.

Patient Experience

During Procedure:

• The patient will be under general anesthesia and will not feel pain.

After Procedure:

• Post-operative pain and discomfort managed with medication.
• Instructions on wound care and activity restrictions.
• Regular monitoring and follow-up visits to ensure proper healing and recovery.

Pain management and comfort measures will be provided throughout the recovery period to ensure patient well-being.