Myomectomy accurately means surgical removal of fibroids. This is the process of choice for women who have symptomatic fibroids and do not wish to have a hysterectomy. Myomectomy can be performed either by key hole approach (laparoscopically) or by open abdominal approach (by making a larger surgical incision on the abdomen). Laparoscopic myomectomy offers many advantages compared to open abdominal surgery such as:
- Enhanced recovery
- Short hospital stay
- Cosmetically improved scar
- Reduced adhesions (scarring) from the procedure
- Comparable pregnancy rates
Laparoscopic myomectomy is an advanced laparoscopic process and the success depends very much on the experience and expertise of the surgeon.
This process is considered when the biggest fibroid is less than 10cm in size and the total no of fibroids is less than 5. However, sometimes larger and more numerous fibroids can be removed by this route depending on individual circumstances. Usually, if estimated duration of surgery is expected to be less than three hours, a laparoscopic approach is used. Sometimes, it can also be used as a two or three stage process. Certain hormonal injections or tablets can be used to decrease the size of the fibroids to make the procedure easier.
Is there a risk of blood transfusion or a hysterectomy?
Uterine fibroids have a lot of blood supply and are therefore prone to bleeding during removal. With precautions as mentioned above, bleeding is not a big problem and blood transfusion is rarely necessary (less than 10% chance with laparoscopic myomectomy). With meticulous planning, pragmatic decision-making and judicious use of blood transfusion, hysterectomy is almost never necessary as result of intra-operative bleeding.