La myomectomy is a surgical procedure that is carried out to remove the fibroids, very common benign tumors during the childbearing age that grow inside or along the walls of the uterus, this cause is known as uterine myomatosis. The myomectomy It is a safe and effective surgical treatment for the removal of fibroids, suitable for all women with severe symptoms, and always possible when the patient wants to preserve the uterus.
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WHEN IS IT NECESSARY TO PRACTICE A MYOMECTOMY
The fibroids, also called fibroids or leiomyomas, they can be asymptomatic and go unnoticed or, depending on their size and location, they can cause symptoms such as heavy or irregular menstrual bleeding, menstrual periods that last longer than normal, discomfort during intercourse or subfertility, and miscarriages.
Three women out of four will have fibroids at some point in their life, but only one in four will suffer from any of their symptom:
- Heavy menstrual bleeding
- Irregular bleeding
- Menstrual periods that last longer than normal
- Sensation of weight in the lower abdomen
- Need to urinate more often
- Unusual constipation
- Discomfort during sexual intercourse
- Subfertility and miscarriage
- Low back pain in the lower back if the fibroid is large
If the fibroids cause symptoms that affect the daily activity of the patient or make it difficult to carry a pregnancy to term, the myomectomy It is the most appropriate surgical procedure, because it allows to remove fibroids, relieve symptoms and preserve the uterus.
TYPES OF MYOMECTOMY
The myomectomy or removal of uterine fibroids, depending on the size, location and quantity, can be carried out through three access routes:
- Through the abdomen: Abdominal myomectomy.
- Through the vagina and cervix: Hysteroscopic myomectomy.
- Through small incisions in the oblique or very close: Laparoscopic myomectomy.
ABDOMINAL MYOMECTOMY OR LAPAROTOMY
La abdominal myomectomy is a surgical intervention that consists of removing fibroids by performing in the lower abdomen, such as a caesarean section, an incision or open cut, often horizontal and parallel to the waist, where the surgeon accesses the uterus and proceeds to practice the removal of fibroids.
The intervention may require 2 to 3 days of hospitalization, and the patient's recovery may involve 3 to 4 weeks of relative rest.
HYSTEROSCOPIC MYOMECTOMY OR HYSTEROSCOPY
Hysteroscopic myomectomy is a surgical procedure that consists of removing fibroids (without an incision or open cut) through the use of instruments (hysteroscope or resectoscope) that are delivered to the uterus through the vagina and cervix.
El hysteroscope It is equipped with a light and a camera with which an enlarged image of the interior of the uterus is obtained, which is displayed on a screen. Fibroids can be removed with a hysteroscope that is used to remove fibroids from the uterine wall using electrical energy, or with a hysteroscopic morcellator with which the surgeon manually cuts the fibroid.
La hysteroscopic myomectomy it is possible in case the fibroids caused by uterine fibroids are of adequate size and protrude sufficiently in the uterus.
The patient is usually discharged the same day as the intervention, and the patient's recovery may involve about 1 week of relative rest.
LAPAROSCOPIC MYOMECTOMY OR LAPAROSCOPY
La laparoscopic myomectomy it's a technique minimally invasive surgery that allows the patient to intervene and eliminate uterine fibroids by making small incisions and without having to open the abdomen.
La laparoscopic surgery, which is a less invasive option than abdominal surgery, requires considerable experience, specialization, and expertise on the part of surgeons.
In a laparoscopic myomectomy, small incisions are made in the navel or very close, through which the surgical instruments and a tube with a small camera (the laparoscope) are inserted and the intervention is carried out to remove the fibroids.
La myomectomy of Single Port or Single Port It is laparoscopic surgery that is performed through a single micro-incision in the abdomen (usually in the navel) through which the surgical instruments are inserted, including the camera that allows the interior to be visualized.
La robotic myomectomy is laparoscopic surgery robot-assisted, a surgery especially suitable for carrying out highly complex surgical procedures. By means of robotic arms and articulated forceps, the robot moves in real time and with absolute fidelity the movements of the surgeon's hand.
The use of the robot provides the surgeon with greater safety to treat anatomical areas of difficult access, facilitates an enlarged view of the interior of the patient, ensures stable handling of surgical instruments and enables maximum precision in the movements of the surgeon's hands.
The advantages and benefits of laparoscopic myomectomy, a minimally invasive surgery, compared to conventional open surgery are numerous:
- Less postoperative pain.
- Less medication.
- Less inflammatory reaction.
- Lower risk of infection.
- Shorter hospital stay.
- Much faster recovery of the patient.
- Aesthetic results that are often practically imperceptible.
Recovery from laparoscopic surgery is faster than from abdominal myomectomy: the patient may be discharged the same day as the intervention, and her full recovery may involve 2 to 3 weeks of relative rest, during which she is recommended to avoid intense exercise.
HOW TO PREPARE FOR THE INTERVENTION
It is recommended that the patient reduce stress in the days prior to the intervention, do not consume tobacco (because it may hinder postoperative recovery), do not drink alcohol during the 48 hours prior to the intervention and follow the instructions of her gynecologist to maintain a soft diet.
It is essential that the patient inform her surgeon in advance about medications, supplements or natural remedies that she may be taking, so that he can tell her how to proceed the days before the intervention.
HOW LAPAROSCOPIC MYOMECTOMY IS PERFORMED
La laparoscopic surgery It is done through small painless incisions through which a tube with a small camera (the laparoscope) controlled by a second surgeon, which makes it possible to view the inside of the abdomen on a screen placed in the same operating room and guide the surgeon inside the body.
- To perform laparoscopy, general anesthesia is usually applied.
- Instead of opening (as in a cesarean delivery), one or more small painless incisions are made very close to the belly button.
- Through the incisions, gas (carbon dioxide) is introduced to bulge the abdomen and provide space and visibility for the surgeon.
- A tube with a small camera (the laparoscope) is placed through the incision.
- Surgical instruments (forceps, scalpel, and other very small devices) are inserted, allowing the surgeon to manipulate internally without having to open the abdomen.
- The camera allows the inside of the abdomen to be visualized on a screen placed in the operating room.
- When the intervention is over, the incisions are closed with simple stitches and the patient is very often discharged the same day as the intervention.
WHAT IS POSTOPERATIVE RECOVERY?
Myomectomy recovery time varies depending on the approach route:
- Abdominal myomectomy. As it is open surgery, this therapeutic option is the one that requires the longest hospitalization and postoperative recovery time. Often times, the intervention may require 2 to 3 days of hospital stay, and recovery can take up to 3 to 4 weeks.
- Hysteroscopic myomectomy. Once the hysteroscopic myomectomy has been carried out, the patient can be discharged the same day as the intervention, while postoperative recovery can involve around 1 week of relative rest, during which the patient is recommended to avoid practicing intense exercise .
- Laparoscopic myomectomy. Postoperative recovery from laparoscopic surgery, a non-invasive surgical technique, is much more comfortable and faster than conventional open surgery.
The patient is usually discharged and left the hospital on the same day as the intervention, and postoperative recovery can last up to 2 or 3 weeks, during which time the patient is advised to avoid strenuous exercise.
Dr Francisco Carmona
Women's Medical Director