Myomectomy is a type of surgery performed to remove fibroids in the uterus. A gynecologist might recommend hysteroscopic myomectomy if the female’s fibroids are causing symptoms like-
- Pelvic pain
- Heavy menstrual cycle
- Irregular spotting or bleeding
- Frequent need to urinate
A hysteroscopic myomectomy can be performed one of the following three ways-
- Abdominal myomectomy- This procedure lets the surgeon remove the fibroids through an open surgical cut in the lower belly.
- Laparoscopic myomectomy- This procedure allows the surgeon to remove the fibroids through small incisions. This surgery can also be performed robotically. It is a less invasive procedure with faster recovery than with abdominal myomectomy.
- Hysteroscopic myomectomy- This procedure requires the surgeon to use a special scope to remove the fibroids through the vagina and cervix.
Why is hysteroscopic myomectomy done?
The gynecologist might recommend hysteroscopic myomectomy for fibroids which cause symptoms that are troublesome for the female or interfere with the normal activities. If the female needs surgery, reasons it might be better for her to choose a myomectomy instead of a hysterectomy for fibroids can be-
- She plans to have children in the future
- The gynecologist suspects uterine fibroids might be interfering with her fertility
- She wants to keep her uterus
Who is a good candidate for Hysteroscopic Myomectomy?
Hysteroscopic myomectomy is a good surgical option for females with fibroids who want to get pregnant in the future or want to keep the uterus for any other reason.
Unlike a hysterectomy, which takes out the female’s entire uterus, hysteroscopic myomectomy removes the fibroids but leaves the uterus in place. This surgery allows the female to try having a baby in the future.
The type of hysteroscopic myomectomy the gynecologist may recommend depends on the size and location of the fibroids-
- Abdominal myomectomy may be considered best if the female has many or very large fibroids growing in the uterine wall.
- Laparoscopic myomectomy may be considered if the female has smaller and fewer fibroids.
- Hysteroscopic myomectomy may be considered if the female has smaller fibroids inside her uterus.
What can you expect after a Hysteroscopic Myomectomy?
Depending on the size, number and location of the fibroids, the gynecologist may choose one of the following three surgical approaches to hysteroscopic myomectomy.
In abdominal myomectomy (laparotomy), the surgeon will make an open abdominal incision to access the uterus and remove fibroids. The surgeon will generally prefer to make a low, horizontal incision near the bikini line, if possible. Vertical incisions may be needed for females with larger uteruses.
Laparoscopic myomectomy is a minimally invasive procedure in which the surgeon accesses and removes the fibroids through small incisions in the abdomen.
In the procedure, the surgeon will make a small incision in or near the belly button. Then a laparoscope (narrow tube fitted with a camera) is inserted into the abdomen. The surgeon performs this surgery with instruments inserted through other small incisions in the abdominal wall.
To treat small fibroids that bulge significantly into the uterus (known as submucosal fibroids), the surgeon might suggest a hysteroscopic myomectomy. The surgeon will access and remove the fibroids using instruments inserted through the female’s vagina and cervix into the uterus.
Results of Hysteroscopic Myomectomy
After the procedure, the doctor might prescribe oral pain medication, and suggest the female how to care for herself and discuss restrictions on the diet and activities for the recovery period. The female might experience some vaginal spotting or staining for a few days up to 6 weeks, depending on the type of procedure she has had.
Outcomes from hysteroscopic myomectomy include-
- Relief from symptoms- After the myomectomy, most females experience relief of troubling signs and symptoms, including excessive menstrual bleeding and pelvic pain and abdominal pressure.
- Fertility improvement- Females who undergo laparoscopic myomectomy have good pregnancy outcomes within about a year of the procedure. After the myomectomy, the doctor suggests you wait for about 3 to 6 months before trying conception to allow the uterus time to heal.
Some females with new or recurring fibroids might be suggested a hysterectomy if they do not wish to have children in the future.
Recovery after Hysteroscopic Myomectomy
The female may have some pain after hysteroscopic myomectomy. The doctor can prescribe medication to treat the discomfort. The female might also have spotting for a few days to weeks, depending on the type of hysteroscopic myomectomy she had. Recovery times for each type of myomectomy are-
- Abdominal myomectomy: 4 to 6 weeks
- Laparoscopic myomectomy: 2 to 4 weeks
- Hysteroscopic myomectomy: 2 to 3 days
The female is strongly suggested to not lift anything heavy or exercise strenuously until her incisions have fully healed. The doctor will let her know when she can return to such activities.
What are the complications and risks of Hysteroscopic Myomectomy?
Any surgery can have risks, and hysteroscopic myomectomy is no different. Risks of hysteroscopic myomectomy are rare, but they may include-
- Damage to nearby organs
- Excessive bleeding
- A hole (or perforation) in the uterus
- Scar tissue that could block the fallopian tube or cause fertility problems
- New fibroids that can require another removal procedure
Call your gynecologist right away if you have any of the following symptoms after the procedure-
- Heavy bleeding
- High fever
- Severe cramps or pain
- Difficulty breathing