Myomectomy

If a fibroid isn’t causing any symptoms, it won’t need to be treated.

If you are experiencing symptoms that impact your quality of life, it is advisable to schedule an appointment with one of our skilled gynaecologists. Our goal is to offer a comprehensive service, ensuring you leave your appointment with a clear diagnosis and an understanding of your next steps.

During your visit, your gynaecologist will gather a detailed medical history and inquire about your symptoms, including when they began, whether they have worsened, and if they are new or recurring. They will then perform a physical examination and conduct an ultrasound scan to confirm your diagnosis.

If you do have a fibroid (or fibroids), the ultrasound scan will show your doctor its location, size and type.

Just because you have fibroids, it doesn’t mean you will need surgery. In the first instance, your gynaecologist will prescribe medications to address your symptoms, such as heavy periods and pain. If these do not provide relief, they may prescribe medications that aim to shrink the fibroid. One such medication is gonadotropin releasing hormone (GnRH) agonists, which can help reduce the size of fibroids before surgery.

If the medicinal approach does not alleviate your symptoms, your gynaecologist will recommend surgery to treat fibroids.

Preparing for surgery

If you decide to proceed with surgery, we will help you prepare. Leading up to the procedure, maintaining a healthy diet and quitting smoking, if possible, can be beneficial.

Inform your gynaecologist immediately if you’re taking blood thinners like Warfarin or aspirin, as you may need to adjust or stop them a week before surgery. Your gynaecologist will provide specific instructions if this applies to you. Also, let them know if you use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Bring any prescription medications with you to the hospital, and your doctor will advise whether you can take them with a sip of water before surgery or if they should be taken afterward.

On the day of surgery, wear loose, comfortable clothing and bring a small bag with essentials. Pack a toothbrush and toothpaste, your phone and charger, a book, and any prescription medications.

After you arrive and settle into your room, a nurse will get you ready for surgery by checking your vital signs, reviewing your medical history and medications, and confirming your emergency contacts. Before the procedure, your doctor will go over the details with you again and ask you to sign a consent form.

There are several types of myomectomies, each with its own approach and considerations. The selection of a specific myomectomy type is influenced by factors such as the size, quantity, and location of your fibroids, along with your overall health and reproductive aspirations.

The three common types of myomectomy are:

Laparoscopic myomectomy:

A laparoscopic myomectomy is performed if the fibroids are small to moderate in size. This is a minimally invasive day-case surgery, which means you can be treated and go home after a one- or two-night hospital stay.

A laparoscopic myomectomy is done under general anaesthetic, so you will be asleep.

Then, small incisions, typically ranging from 0.5 to 1.2 centimetres, will be made in the abdomen. Trocars (hollow tubes) are inserted through these incisions to provide access for specialised laparoscopic instruments.

The abdomen will then be expanded with carbon dioxide, so your surgeon has the clearest view possible of your uterus. A laparoscope, which is an instrument with a tiny camera and light, will guide the operation. Once located, the fibroids will be removed via the small incisions. In some cases, techniques like uterine artery embolization may be used to block the blood vessels supplying the fibroids, aiding in their removal.

After the fibroids are removed, the carbon dioxide used to expand your abdominal cavity will be released, and the small incisions will be closed using stitches or medical adhesive. A protective bandage will then be applied over the incision sites.

Patients usually experience reduced pain, smaller scars, and a faster recovery compared to traditional open surgery.

Abdominal myomectomy

An abdominal myomectomy is also referred to as an open myomectomy. It may be recommended if you have many fibroids or large fibroids. The procedure involves making a larger incision through your abdomen, providing direct access to the uterus. This is normally horizontal and on the lower abdomen. However, if your uterus is larger, the fibroids are higher up or you have a scar from a previous surgery, your surgeon may make a vertical incision.

Once the fibroid(s) has been removed, the surgeon will close the wound with surgical stitches.

You will need to stay in hospital for one or two nights after this surgery and recovery will take a few weeks.

Hysteroscopic myomectomy

An hysteroscopic myomectomy is ideal for women who suffer with submucosal fibroids or have small fibroids that do not sit deep in the uterine lining. It is the least invasive of the procedures and requires no incisions.

In this procedure, an hysteroscope (a tube with a tiny camera, a light and a tool for removing fibrotic tissue) is inserted into the uterus via the vagina and cervix. The hysteroscope is then used to shave off the submucosal fibroids.

This is a day-patient procedure, so you can be treated and go home the same day. It can be performed under general anaesthetic or sedation.

Following the surgery, you’ll be taken to our recovery area where our specialized staff will closely monitor your vital signs as you awaken from anaesthesia. If you underwent a laparoscopic myomectomy, you might experience bloating due to the carbon dioxide used during the procedure.

The recovery process will depend on the type of myomectomy you had. After the surgery, a friend or family member will need to take you home as you are not allowed to drive after anaesthesia or sedation.

After a myomectomy, you may experience:

• Cramping
• Pelvic pain
• Spotting similar to your menstrual period
• Light vaginal bleeding and discharge are common and expected for a period of 1-2 weeks following surgery

Depending on the myomectomy you had, your recovery will range from a couple of days (hysteroscopic) to 2-3 weeks (laparoscopic) or 4-6 weeks (open).

For those who wish to conceive, the timing for attempting pregnancy after a myomectomy depends on factors such as the type of surgery you had, the extent of fibroid removal, and individual healing.

It’s important patients closely follow our postoperative instructions, attend follow-up appointments, and communicate any concerns or unusual symptoms. Adhering to postoperative care guidelines is crucial for a successful recovery and optimal long-term outcomes.

Recovery and Aftercare

Recovery and aftercare are crucial aspects of the myomectomy process. Proper care and attention can help minimise complications, reduce discomfort, and promote a smooth healing process.

Immediate Post-Surgery Care

After the surgery, you will be taken to the recovery room where you will be monitored for a few hours. Your healthcare team will:

• Monitor your vital signs, such as blood pressure, heart rate, and oxygen levels
• Administer pain medication to manage discomfort and pain
• Provide instructions on how to care for your wound and manage any bleeding or discharge
• Encourage you to move your legs and take small walks to prevent blood clots

It’s essential to follow your healthcare team’s instructions carefully to ensure a smooth and safe recovery.

Long-term Recovery Tips

To promote a successful recovery, follow these long-term recovery tips:

• Rest and avoid heavy lifting, bending, or strenuous activities for 4-6 weeks
• Take pain medication as directed by your healthcare team
• Follow a healthy diet and stay hydrated to promote healing
• Avoid smoking and second-hand smoke to reduce the risk of complications
• Attend follow-up appointments with your healthcare team to monitor your progress and remove any sutures or staples

By following these tips, you can minimise the risk of complications and promote a successful recovery.

Risks and Complications

As with any surgical procedure, myomectomy carries some risks and potential complications. These may include:

• Infection: As with any surgery, there is a risk of infection, which can usually be managed with antibiotics.
• Bleeding: Heavy bleeding is a possible complication, especially if the fibroids are large or numerous.
• Adhesions: Myomectomy can cause adhesions (scar tissue) to form in the pelvic cavity, which can lead to bowel obstruction or infertility.
• Infertility: The procedure can weaken the uterine wall, increasing the risk of infertility or miscarriage in future pregnancies.
• Uterine Rupture: Women who become pregnant after a myomectomy are at risk of uterine rupture, especially if the fibroids were large or numerous.

It’s essential to discuss these risks and complications with your doctor before undergoing myomectomy. Your doctor can help you weigh the benefits and risks of the procedure and determine if it’s the right option for you. Understanding these potential outcomes will help you make an informed decision about your treatment and ensure you are prepared for the recovery process.