January 15, 2017 Liza Colimon, MD Myomectomy is the term used to describe a surgical procedure which is performed to remove fibroid tumors. Fibroids are usually non-cancerous smooth muscle tumors that can grow from within the wall or the lining of the uterus, or into or on the cervix. Fibroid tumors can cause heavy bleeding during your menstrual cycle, irregular bleeding, pain, pressure, and occasionally frequent urination or constipation. Myomectomy is the preferred treatment for women who want to keep their uterus, or because future fertility is desired. Indications for Myomectomy You may need a myomectomy if: You have multiple fibroids causing symptoms you do not like You have very heavy periods You suffer from anemia because your periods are so heavy The fibroids you have are the cause of your bleeding and pain You want children in the future Surgical Approaches to Myomectomy Procedures These are the four approaches to performing a Myomectomy. Hysteroscopic Myomectomy Laparoscopic Myomectomy Robotic Assisted Laparoscopic Myomectomy Abdominal Myomectomy Which Procedure you have will be determined by your medical and surgical history, your physical exam findings, the size, number, location and look of your fibroids on ultrasound or Magnetic Resonance Imaging (MRI), and the skill level and experience of your surgeon. Hysteroscopic Myomectomy If the fibroid/fibroids are small and located mostly within the inside of the uterine cavity, the procedure may be performed with a hysteroscope. This scope is a camera placed inside a long metal tube which is passed through the cervix and into the uterus and allows the surgeon to directly see inside the uterus. If a fibroid is present, a small loop is used to cut the fibroid away from the uterine wall. No incisions are necessary on your abdomen or on your pelvic organs or vagina. You may experience some light vaginal bleeding or spotting after this procedure. This procedure does not require an overnight stay in the hospital. Laparoscopic Myomectomy Depending on the size and location of your fibroids you may be a candidate for a laparoscopic myomectomy . Laparoscopic surgery is a type of minimally invasive surgery in which small incisions (cuts) between 0.5 to 1 cm are made on the abdominal wall through which an instrument called a laparoscope can be placed. The laparoscope allows the surgeon to see inside the abdomen and pelvis. The abdominal cavity is able to be visualized by distending it with an absorbable gas, typically, carbon dioxide. Small instruments can be placed through the small incisions allowing the surgeon to remove the fibroids and repair the uterus with stitches without the need for a large surgical cut on the belly. Patients must receive general anesthesia during the procedure and often go home the same day as surgery or may stay overnight in the hospital for monitoring. Advantages of laparoscopy over traditional abdominal surgery include: Shorter post-operative hospital stay Shorter recovery interval Less pain Less blood loss Robotic- assisted Laparoscopic Myomectomy A Robotic- assisted Laparoscopic Myomectomy is a type of minimally invasive myomectomy utilizing robotic technology and laparoscopic surgery. This procedure allows the surgeon enhanced 3 dimensional visualization and greater maneuverability over laparoscopy for suturing (sewing) the uterine wall and layers of the uterus affected by the fibroids closed after all fibroids are removed. All robotic instruments and the robotic camera are directly controlled by the surgeon. The procedure is performed using a similar approach to that performed during a laparoscopic myomectomy, however the incisions made on the abdominal wall are a slightly higher and slightly larger by 2-5mm. Small incisions ranging in size from 1-2.0 cm are made on the abdominal wall. A Robotic-assisted approach may be more beneficial for patients who have several fibroids that are growing deep into the uterine wall requiring a more extensive type of suturing (sewing) of the uterine wall. A minimally invasive myomectomy may not be the procedure of choice for you if you have many fibroids, or many small fibroids. Like laparoscopic surgery, a Robotic- assisted procedures allows for a faster recovery, shorter post-operative stay, and less pain than the traditional abdominal approach. Abdominal Myomectomy An Abdominal Myomectomy is the removal of fibroids from an open abdominal incision (cut on the belly). Abdominal surgery requiring larger incisions is referred to as a Laparotomy incision. The size and location of the incision will depend on the size and number of fibroids one has. The abdominal approach is usually reserved for patients with a large number of fibroids, or very large fibroids. The advantages of the Abdominal myomectomy in this setting is that it allows the surgeon the ability to actually feel the uterus and allows the surgeon to find fibroids deep inside the uterus that may not be visible just by looking laparoscopically or robotically. The disadvantages are a longer hospital stay, longer recovery period, greater risk of blood loss, and pain. Patents typically require a 48 to 72 hour hospital stay depending on the size of the incision. Women who have this surgery performed by a Mini-laparotomy, which is a much smaller cut on the belly, often can go home the same day or within 24 hours.