Fibroid Removal Myomectomy

Overview of Fibroid Removal Myomectomy in India

A myomectomy is a procedure where fibroids are removed from the uterus surgically. Fibroids develop in the uterus, creating healthy growing environments for baby development, and are mostly benign tumours, but can be malignant. Fibroids, also known medically as leiomyomas, develop over many years when a woman can become pregnant and throughout most of her life.

Uterine fibroids are benign masses, but can cause serious complications, such as heavy menstrual bleeding and pelvic pain. The purpose of a myomectomy is to remove the fibroids that cause these types of complications.

Once the fibroid is removed, the uterus is then repaired and remains in the body. In contrast, the uterus is completely removed in a hysterectomy, while the uterus remains in the body following a myomectomy.

What is a Myomectomy?

A myomectomy ( meaning fibroid removal surgery ) is a procedure for taking out fibroids, also known as uterine leiomyomas, from inside the uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy is more about extracting the fibroids only while keeping the uterus. Because of that, it becomes a really important choice for women who want to maintain their uterus for future pregnancies, or for more personal reasons.

The operation itself can happen in a few different ways, depending on the size, the number, and where the fibroids are located. The whole point is to reduce symptoms like heavy bleeding, pelvic discomfort, or fertility concerns. At the same time, it tries to protect the uterus's structure and its normal function, so everything stays as close as possible to what it was before.

Types of Fibroid Removal Myomectomy:

Fibroids can be removed using several different surgical techniques, and the path that your doctor chooses will depend on how many fibroids there are, the size of the fibroids and their locations. In general terms, your doctor can remove fibroid tissue using either an open (larger incision) or minimally invasive (smaller incision or no incision) technique called myomectomy (removal of fibroid tissue). Open surgery is typically used for the removal of very large and/or numerous fibroids, while minimally invasive methods typically have shorter recovery time, less pain, and lead to smaller scars.

Open Myomectomy (Abdominal Myomectomy)

This is considered the most classic and invasive myomectomy (operation for removing fibroids). The surgeon creates a single massive incision in the lower abdomen (just like with a C-section). This is done to directly access the uterus. This would typically be the best option for those with many or very large fibroids that can't be removed using a less invasive method. Since this will require a larger incision, it is considered major surgery with a longer recovery time (usually 4-6 weeks). Patients will have more pain and create a larger scar than with any of the other methods.

Minimally Invasive Myomectomy

The term "minimally invasive" encompasses any procedure where the incision made is smaller than traditional-method incisions (or in some cases, there is no incision at all). The procedure generally results in less post-operative discomfort, shorter time for recovery compared to open procedures, and smaller scars.

Minimally invasive procedures can be categorised into three different sub-groups, depending upon where the fibroid is located and its size.

Laparoscopic Myomectomy

This minimally invasive surgery is performed by making multiple tiny incisions in your abdomen with the aid of small cameras and other instruments, and is typically reserved for patients with few but larger fibroids. The recovery time required after laparoscopic fibroid removal is typically much shorter than that associated with surgical removal of fibroids using a larger incision (open surgical removal). Most patients will take approximately two to four weeks to fully recover after laparoscopic fibroid removal surgery.

Robotic Myomectomy

This is a kind of myomectomy, basically fibroid removal surgery, where the surgeon uses a robot, sort of, to help out during the operation. The surgeon then guides robotic arms to move the instruments with a lot of accuracy. In practice, it gives you similar advantages to a regular laparoscopic procedure, like quicker recovery and small, low-visibility scarring. And robotic tech can be especially useful for tricky cases, the ones that are good candidates for a minimally invasive route.

Hysteroscopic Myomectomy

This is a minimally invasive procedure with no abdominal incisions necessary. Using a gentle technique, the surgeon will place a thin, lighted instrument through the vagina and cervix into the uterus. This surgical technique specifically applies to fibroids found on the inside of the uterus. The most advantageous aspect of a hysteroscopic procedure is that recovery is fast (usually in a few days).

Procedure:

Getting a sense of what may happen at each stage helps patients and their families feel far more ready, and honestly a bit calmer too. The pathway usually runs through three main phases: before anything starts, what is happening on the day of surgery, and then postoperative recovery afterwards.

Pre-Operative Preparation

Medical evaluation: A pretty thorough medical assessment is done to make sure a patient is overall well and ready for surgery. Usually this means a physical exam, plus imaging like an ultrasound, to get a more precise look at the fibroids. Blood work is also carried out to spot any issues that could make the operation harder. For example, blood tests can show anemia, meaning a low red blood cell count, and they can also confirm the patient’s blood group, just in case a transfusion becomes necessary.

Medication adjustments: The medical team gives clear directions about which medicines, especially blood thinners, need to be reduced or paused before surgery. The idea is to minimise the chance of bleeding.

Lifestyle recommendations: Doctors often suggest stopping smoking if the patient does smoke, because it can slow down the repair and healing process.

Fasting instructions: Patients get detailed guidance on when to stop eating and when to stop drinking before the procedure.

Practical planning: Patients are asked to organise support at home, like help with chores, childcare, and transport back and forth, for at least a short while after they return home.

On the Day of the Procedure

Admission to Hospital- The patient will be checked into the hospital and will have the appropriate preparations and final checks done by the medical staff. 

Anesthesia- The anesthesiologist will give the patient general anesthesia, making them comfortable and sleeping through the complete procedure. 

The Surgical Procedure- The myomectomy will be performed by the surgeon; the specific type (open, laparoscopic, robotic, hysteroscopic) of procedure will be based on the initial discussion with the physician and how many and what size of fibroids are being treated. Surgery duration will also vary based on fibroid size and number. 

Initial Recovery After Surgery- The patient will be recovered in the recovery room by a nurse who closely monitors the patient while they are waking up from anesthesia. Once fully awake, the patient will be taken to their hospital room.

Post-Operative Care and Recovery

Pain Control: You may experience some level of pain after your surgery (myomectomy); therefore, your physician will provide you with medication to help control your pain during recovery.

Mobilising Early: As soon as it is safe for you to do so (usually within 24 hours after surgery), your medical team will encourage you to get out of bed and walk around. Doing so will help prevent complications and promote your recovery.

Restrictions on Activity: There will be specific instructions about the types of activities you should avoid (i.e. do not lift anything heavy, do not engage in activities that are physically strenuous for you, do not use tampons or have sexual intercourse for a specified period of time, and do not lift anything over a certain weight) in order for your uterus to heal properly.

Rehabilitation: While physical therapy is not typically indicated for women recovering from a myomectomy, there may be some gentle exercises that your doctor will recommend in order to help you regain your strength and mobility after surgery.

Follow-Up Visits: After your surgery, the doctor will schedule multiple follow-up appointments to monitor your recovery progress.