Myomectomy - Surgery, Procedure, Complications, Results

Myomectomy is a surgical procedure performed to remove uterine fibroids, also called leiomyomas. These are non-cancerous growths of tissue that develop in the uterus. Unlike a hysterectomy, which involves removing the entire uterus, myomectomy preserves the uterus while addressing fibroid symptoms. 

Depending on the size, number, and location of the fibroids, myomectomy surgery can be performed through various techniques. These include abdominal, laparoscopic, or hysteroscopic procedures. 

Anatomy and Physiology of the Uterus

The uterus is a pear-shaped organ in the pelvis between the bladder and the rectum. It has a crucial role in reproduction, as this is where a fertilised egg implants and develops into a foetus during pregnancy. The anatomy of the uterus is as follows: 

1. It consists of three main parts, which are the fundus (upper portion), the corpus (main part), and the cervix (lower narrow part).

2. The inner lining of the uterus is the endometrium, which thickens and sheds during the menstrual cycle.

3. The muscular layer of the uterus is called the myometrium and is responsible for contracting during labour. 

4. The outermost protective layer of the organ is known as the perimetrium.

The need for a myomectomy arises when uterine fibroids cause symptoms that significantly affect a woman’s quality of life or reproductive health. Common indications for this procedure include:

1. Symptoms such as heavy menstrual bleeding, irregular bleeding, pelvic pain, and urinary problems 

2. Infertility problems caused by fibroids 

3. The ability to conceive and bear children

The exact duration of myomectomy surgery can vary depending on the type of procedure and the number of fibroids. It generally takes two to three hours. Performed under general anaesthesia, it involves the following: 

1. Abdominal Myomectomy: Also known as open myomectomy, this traditional approach may be recommended for larger fibroids or when multiple fibroids are present.

1. It involves making an incision in the abdomen, either a horizontal ("bikini") or vertical incision, to access the uterus. 

2. The surgeon removes the fibroids from the uterine wall and closes the incision. 

2. Laparoscopic Myomectomy: It is a minimally invasive approach that involves four small incisions in the abdomen. 

1. The surgeon inserts a laparoscope (a thin, lighted tube with a camera) and surgical instruments through these incisions. 

2. They cut the fibroids into smaller pieces to remove them through the vagina or abdominal openings. 

3. In some cases, robotic arms are used to control the movements of instruments (robotic myomectomy).

3. Hysteroscopic Myomectomy: This procedure is performed through the vagina and cervix without any external incisions. It is ideal for treating submucosal fibroids (that bulge into the uterine cavity).

1. A hysteroscope (a thin tube with a camera) is inserted through the cervix into the uterus. 

2. A liquid is inserted into the uterus to expand the uterine cavity. 

3. The surgeon uses a wire loop to remove fibroids that are located within the uterine cavity. 

Note: The treatment approach is selected based on the size, number, and location of uterine fibroids. 

Patients preparing for fibroid surgery will receive specific instructions from their gynaecologist or surgeon to ensure a smooth operation. The guidelines before and on the day of the procedure include:

Before Myomectomy 

Individuals who smoke will be asked to quit smoking six to eight weeks before surgery. Medication for uterine fibroids and other preparations before myomectomy are as follows: 

On the Day of Myomectomy 

Patients should plan to arrive at the hospital before the scheduled time for their myomectomy procedure. This allows them to complete any necessary paperwork efficiently. Once they arrive, they will be prepped for surgery, which includes the following: 

It is expected to experience vaginal spotting or straining after the procedure. This can last up to six weeks, depending on the type of myomectomy. Patients can generally manage these symptoms by following the instructions provided by their doctor. 

Recovery in the Hospital 

The duration of hospital stay depends on the type of procedure the patient has undergone. They may go home the same day after hysteroscopic or laparoscopic myomectomy but might need 1-2 days in the hospital post-abdominal surgery. During this stay, individuals can expect the following: 

1. After the surgery, patients are closely monitored in the recovery room until they wake from anaesthesia. The medical staff check their vital signs, pain levels, and potential complications like bleeding. 

2. Patients receive pain medication as needed to manage discomfort.

3. They are encouraged to move and walk around as soon as they feel comfortable to prevent blood clots and promote circulation.

At-home Recovery 

Recovery from myomectomy depends on the surgery type. Patients undergoing hysteroscopic myomectomy can expect to recover within two days. After laparoscopic procedures, individuals need two to three weeks to return to normal activities. Open surgery takes four and six weeks for recovery. During this period, it is important to follow these guidelines: 

1. Continue to take pain medication as prescribed to manage discomfort at home.

2. Avoid strenuous activities or heavy lifting for the first week after surgery or longer for open myomectomy. 

3. Refrain from sexual intercourse for six weeks. 

4. Wait 3-6 months before trying to conceive. 

First Follow-Up Appointment 

After fibroid removal surgery, patients will have a follow-up visit with their surgeon in two to six weeks to monitor recovery. 

Additionally, they will undergo pelvic exams and ultrasounds at three months, six months, and one-year post-surgery. If no new fibroids are detected after one year, the doctor will suggest annual check-ups.

According to Khaw et al., 2020, 75.6% of women suffering from fibroids became pregnant after myomectomy. The significant benefits that make it a preferred procedure are as follows: 

1. Fertility Preservation: Myomectomy helps women have children in the future because it removes fibroids while leaving the uterus intact. It can improve fertility outcomes within one year of the procedure. 

2. Symptom Relief: By removing fibroids, myomectomy effectively alleviates symptoms such as heavy menstrual bleeding, pelvic pain and pressure. 

3. Minimally Invasive Options: It can be performed using less invasive techniques such as laparoscopic or hysteroscopic myomectomy. These approaches involve smaller incisions, shorter hospital stays, and faster recovery than traditional open surgery.

According to a study by Alharbi et al., 2020, the complication rate after myomectomy was 9.5%. The risks can vary depending on the type of surgery performed and may include the following: 

1. Excessive bleeding 

2. Infection at the incision site 

3. Formation of scar tissue at the site of fibroid removal, which can affect fertility 

4. Damage to nearby organs like the bladder 

5. Weakened uterine walls that may require future pregnancies to be delivered via cesarean section 

6. New fibroids that require another procedure 

When to call a doctor?

After a myomectomy, it is important to monitor any signs of complications. Patients should contact their doctor if they experience the following symptoms: 

1. Fever above 100.4℉

2. Severe pain that does not improve with medications 

3. Heavy bleeding

Delaying a myomectomy when required can lead to several complications associated with the continued growth of fibroids. The following are some of the risks involved:

1. Increased Symptoms: These include heavy menstrual bleeding, pain, and pressure that significantly impact quality of life and lead to conditions such as anaemia.

2. Fertility Issues: Larger fibroids can change the shape of the uterus, affecting fertility and the ability to carry a pregnancy to term. However, this risk is rare. 

3. Complications During Pregnancy: If pregnancy occurs before treatment, larger fibroids might lead to certain complications. These include placental abruption (the placenta separates from the uterus), foetal growth restriction, and preterm labour.

Cost of Myomectomy 

The fibroid surgery cost in India can vary widely based on several factors. It generally starts from ₹ 40,000 and reaches ₹ 1,20,000. The average expense of the procedure is ₹ 90,000. 

Note: For the accurate cost of the procedure, patients should consult HexaHealth experts. 

Factors that affect the price of myomectomy include: 

1. Type of Myomectomy: The surgical approach used significantly affects the cost. Laparoscopic and robotic myomectomies are more expensive due to the advanced technology and equipment required.

2. Surgeon’s Expertise: Highly skilled surgeons specialising in minimally invasive gynaecological surgeries charge more for their services.

3. Hospital Fees: Private facilities are costlier than public ones because of better amenities. Additionally, expenses can vary based on the location. Hospitals in urban areas have higher rates than those in rural areas.

4. Hospital Stay: Longer stays in the hospital lead to higher overall costs. This duration depends on the type of myomectomy performed and the patient’s recovery.

5. Insurance Coverage: Whether or not the patient’s health insurance covers the procedure can impact the out-of-pocket expenditure.

By removing uterine fibroids, myomectomy helps alleviate symptoms like heavy menstrual bleeding and pelvic pain. This option is particularly beneficial for those who wish to preserve their fertility. Recovery times vary, but most women see significant improvements in their overall quality of life after surgery.

At HexaHealth, we can help you access the best treatment for fibroids in your city. Our team provides personalised care, from hospital admissions to post-operative care. With expert doctors and state-of-the-art facilities, we are committed to ensuring you receive the highest standard of care. 

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