Uterine fibroids are very common benign growths that more than 50 per cent of women will experience. While they are mostly harmless, they can pose health complications and fertility risks.
Myomectomy for uterine fibroids
Following comprehensive diagnosis, Dr Alex can perform a myomectomy, a procedure that is performed laparoscopically or abdominally. In many cases, this surgery can effectively extract fibroids without having to remove the uterus. In most cases this can be done through key-hole surgery with minimal scarring and fast recovery.
Am I candidate for fibroid surgery?
You may be a candidate for surgical treatment in the following cases:
- Do not respond to conservative treatments
- Post menopause, with growing tumours
- Grow large enough to cause pressure on other organs, such as the bladder
- Grow rapidly
- Profuse bleeding that can lead to anaemia and lifestyle problems
- Chronic abdominal pain, or pelvic or lower back pressure
- Cause problems with regard to fertility
How do I prepare for surgery?
You will be advised to stop eating or drinking anything at least 6 hours before the procedure. Discuss all the medications that you are taking on a regular basis so that your doctor can advise you on the ones that you can safely continue and those that may need to be stopped during the time of surgery.
How is surgery for fibroids performed?
Fibroid surgery can be performed by an open or minimally invasive laparoscopic approach. While open surgery requires a large incision on your abdomen to access the fibroids, laparoscopy requires only small incisions to allow the insertion of surgical instruments and a narrow lighted tube with a camera, called a laparoscope. The scope relays images of the surgical site onto a large monitor, which can be viewed by your surgeon.
What is laparoscopic myomectomy?
Laparoscopic myomectomy is a minimally invasive surgical procedure performed to excise uterine fibroids.
Your surgeon will cut the fibroid into pieces using laser, cryotherapy (extreme cold) or cautery (extreme heat), and remove them through a small incision made in the abdominal wall. A larger incision is required if the fibroid is removed without being cut into pieces. In some cases, the fibroid is removed through the vagina by a process called colpotomy.
Following the excision, the defects are irrigated to control bleeding and sutured.
Your surgeon separates the uterus from the surrounding organs and blood vessels, by ligating and sealing the open ends. The uterus is then removed via the abdominal incision or vagina. Your surgeon will also remove the ovaries only if you have a risk of developing ovarian or breast cancer. Usually, the ovaries are spared.
What can I expect after surgery?
Following laparoscopic surgery, you may be able to go home after a nights stay in the hospital. An open approach may require a longer stay. You will be prescribed pain medication to keep you comfortable and advised to move around after the surgery.
What are the pros and cons of fibroid removal surgeries?
The laparoscopic approach to fibroid treatment is associated with more advantages than open surgery. These include:
- Less blood loss
- Lower postoperative pain
- Fewer complications
- Faster recovery
- Minimal scar formation
An added advantage of myomectomy is the ability to preserve your fertility. However, laparoscopic myomectomy may be associated with challenges in suturing the defect left after the removal of the fibroid as well as the detection and removal of small uterine fibroids, and large fibroids from difficult locations such as lower region of the uterus or junction of the cervix.
On the other hand, while you will not be able to conceive in the future after hysterectomy, the complete removal of the uterus and sometimes the ovaries as well, ensures complete cure of fibroids.
Describe the stages of recovery and care plan?
You can start exercising 2-4 weeks after surgery and have intercourse 8 weeks after surgery. Give your uterus at least three months to heal before attempting to get pregnant after myomectomy. You are advised not to lift any heavy object until 2-4 weeks after surgery.
If your ovaries are removed as well, you will be prescribed hormone therapy to avoid premature menopause and the symptoms such as hot flashes, that are associated with it.
What are the potential complications of fibroid removal surgery?
As with most surgical procedures, fibroid removal surgeries may be associated with certain complications such as:
- Blood clots
- Conversion to an open surgery
- Bowel obstruction
- Injury to neighbouring organs (ureter, bladder, bowel or blood vessels)
- Chances of uterine rupture during labour
What is the downtime of fibroid removal surgery?
You will usually be able to resume your normal work within a week. If you engage in physically demanding work, you are advised to take rest for 2 to 3 weeks.
What is the cost of fibroid removal surgery?
Any costs involved will be discussed with you prior to your surgery.
What is the likelihood of fibroid recurrence? How can it be managed?
Fibroids can recur even after surgery. This may require further surgery.
What are the lifestyle recommendations to manage fibroids?
Menstrual pain caused by fibroids can be managed with:
- Using pads instead of tampons
- Heat application