Name of the Procedure:

Myomectomy, excision of fibroid tumor(s) of the uterus; also known as Fibroidectomy when specifically addressing 1 to 4 intramural myomas with a total weight of 250 grams or less and/or the removal of surface myomas via an abdominal approach.

Summary

A myomectomy is a surgical procedure aimed at removing fibroid tumors from the uterus. This specific type of myomectomy focuses on removing 1 to 4 intramural myomas (tumors within the uterine wall) or surface myomas when the total weight is 250 grams or less. The surgery is done through an abdominal incision.

Purpose

Myomectomy addresses the presence of fibroid tumors in the uterus, which can cause heavy menstrual bleeding, pain, infertility, or other complications. The goal is to remove the fibroids while preserving the uterus and improving symptoms or aiding in reproductive health.

Indications

• Heavy menstrual bleeding
• Pelvic pain or pressure
• Frequent urination due to pressure on the bladder
• Infertility or recurrent miscarriages linked to fibroids
• Enlarged uterus
• Rapid growth of fibroids
• Anemia due to heavy bleeding

Preparation

• Patients may need to fast for 8-12 hours prior to surgery.
• Preoperative blood tests and imaging studies (like ultrasound or MRI) are commonly required.
• Medications such as blood thinners might need to be adjusted or discontinued.
• Patients will receive instructions on what to bring and how to prepare for the hospital stay.

Procedure Description

1. The patient is placed under general anesthesia.
2. A horizontal or vertical incision is made in the lower abdomen.
3. The surgeon locates and excises the fibroids from the uterine wall or surface.
4. The uterine muscle and other layers are carefully sutured to maintain uterine integrity.
5. The incision is closed with sutures or staples, and a dressing is applied.

Tools/Technology:

• Surgical scalpel, scissors, forceps
• Laparoscopic instruments in some cases
• Surgical sutures or staples
• Anesthesia equipment

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and number of fibroids.

Setting

Myomectomy is performed in a hospital operating room.

Personnel

• Surgeons
• Nurses
• Anesthesiologists
• Surgical Technicians

Risks and Complications

Common:

• Bleeding
• Infection
• Pain

Rare:

• Damage to adjacent organs (e.g., bladder, intestines)
• Blood clots
• Postoperative adhesions
• Uterine scarring
• Rarely, a hysterectomy if severe complications arise

Benefits

• Relief from symptoms caused by fibroids, such as heavy bleeding and pain.
• Preservation of the uterus, which is beneficial for women who wish to remain fertile.
• Improvement in the quality of life typically soon after recovery.

Recovery

• Hospital stay of 1 to 2 days post-surgery.
• Full recovery typically takes about 4 to 6 weeks.
• Patients should avoid heavy lifting and strenuous activity during the recovery period.
• Follow-up appointments to monitor healing and address any concerns.

Alternatives

• Medication management (e.g., hormone therapy) to reduce symptoms or shrink fibroids.
• Uterine artery embolization (UAE) to block fibroid blood supply.
• Endometrial ablation for smaller fibroids and symptom relief.
• Hysterectomy for more comprehensive treatment, especially when future childbearing is not a concern.

Pros and Cons:

• Medications are less invasive but may not be as effective long-term.
• UAE is less invasive but might not preserve fertility.
• Hysterectomy is definitive but eliminates the chance of future pregnancies.

Patient Experience

During the procedure, patients will be under general anesthesia and will not feel pain. Post-surgery, patients might experience moderate pain and discomfort managed with prescribed analgesics. Patients can expect some swelling and bruising, and gradual improvement in symptoms over the recovery period. Comfort measures like pain management and support garments may be recommended.