Myomectomy

Uterine fibroids are the most common benign tumors found in the female reproductive tract. They are composed of muscle cells similar to the cells that make up the uterus. They can vary in size from a small pea to a large melon. Fibroid symptoms can range from being asymptomatic (no symptoms) to pelvic pressure and pain and heavy frequent periods. A fibroid uterus is the most common reason for hysterectomy in the United States (account for 30% of all hysterectomy in the U.S.). Most women who have symptoms from their fibroids have hysterectomies performed. However, women who are young, and who would like to preserve fertility have the option of a myomectomy, a surgical procedure that removes the fibroids from the uterus while keeping the uterus intact. Because of high rate of recurrence, a myomectomy is generally not recommended for women who have completed child bearing yet continue to suffer from excessive heavy menstrual periods and from pelvic pressure and pain due to fibroids.

Traditionally a large abdominal incision is required for this procedure but as laparoscopic surgeons have refined their skills over the past 20 years, laparoscopic myomectomy has become a better alternative in the hands of experienced laparoscopic surgeons. In general, laparoscopic myomectomy is more complicated than laparoscopic hysterectomy due to the extensive vascularity of the fibroids and potential for blood loss. Thus extensive experience in laparoscopic surgery is required to perform this procedure.

The physicians at the Women's Surgery Center specialize and limit their practice to laparoscopic surgery, which means they have had extensive training and experience in complicated laparoscopic surgeries including laparoscopic myomectomy and/or laparoscopic hysterectomy for symptomatic fibroids. Numerous complicated laparoscopic myomectomies are performed at the Center each year.

Frequently Asked Questions about Uterine Fibroids

What are the advantages of having a laparoscopic myomectomy?

Laparoscopic myomectomy is removing the fibroids by using laparoscopic surgical techniques. Laparoscopic surgery is a minimally invasive procedure, usually performed as outpatient surgery under general anesthesia. It has revolutionized gynecological surgery because of a shortened hospital stay, better cosmetic appearance, and quick recovery. In laparoscopic surgery, surgeons use electronic eyes (a highly sensitive video camera) instead of their own eyes to do surgery. With a very bright light from a laparoscope directly shining over the surgical field, the operative site is greatly magnified onto several high resolution TV monitors. Heightened visibility of the operative field affords the surgeon to identify and dissect within the right surgical planes more precisely and easily, thus avoiding unnecessary tissue trauma and greatly reducing blood loss during surgery.
Because the incisions are small, recuperation is usually associated with minimal discomfort. Since the abdominal cavity is not opened, bacterial contamination is minimized, and the risk of infection is low. The intestines are not exposed to the drying effect of air or the irritating effects of the sterile gauze pads used to hold the bowel out of the way during the abdominal surgery. As a result, normal functioning of the intestines return almost immediately after the surgery. This not only spares the patient postoperative gas pain, it also avoids days of delay before a person is able to eat. After laparoscopic myomectomy, women usually return to normal activity, work, and exercise within 7-10 days.

As stated previously, laparoscopic myomectomy is technically more difficult than traditional open surgery, necessitating extra training, experience, and high degree of laparoscopic surgical competence. Otherwise, the risks involved with laparoscopic myomectomy performed by an inexperienced surgeon will most outweigh any advantages stated above.

What causes fibroids?

While much is unknown regarding causation of fibroids, we believe that genetic or cell mutation is involved -- complex factors, (environmental, hormonal, and/or aging) that prompt certain individual cells start to growing the wrong way. Strong evidence exists that female hormones (estrogen and progesterone) are necessary for fibroid growth. They do not grow before puberty, and if growth takes place after puberty, shrinkage occurs after the menopause, when the production of female hormones ceases.

Does uterine fibroids relate to fibrocystic change of breasts?

No, they are totally different and unrelated conditions. Development fibroids do not cause increased likelihood for any other benign or cancerous conditions.

Can fibroids cause infertility?

Fibroids are not usually a cause of infertility. In order to cause infertility, fibroids must grow very close to and must actually obstruct the uterine openings of the Fallopian tubes, thereby blocking the passage of the egg as it enters the uterus. Both tubes must be blocked, since only one open tube is needed for pregnancy to occur.

Can fibroids be treated with medication?

Several medications have been marketed to control the symptoms of fibroids. Unfortunately, no medication exist that can permanently shrink the fibroids once they are present. Medication can temporarily reduce the size of the majority of fibroids and decrease the amount of menstrual bleeding, allowing a window of time for some women to prepare physically and emotionally for surgery. Currently, Lupron and Synarel are most commonly used to shrink fibroids. They work by temporarily shutting off the ovary from producing female hormones and stopping menstruation. In about two weeks the medication begins to shrink the fibroids and the full effect is seen after three months. About 75% of treated fibroids will decrease in size by about 50% in three months. The shrinkage is maintained as long as the patient is using medication, but further shrinkage after the third month of treatment is rare. Unfortunately, if the medication is stopped, the ovaries begin to produce female hormones again, and fibroids usually return to their original size within three months. The main side effects of Lupron and Synarel are producing menopausal symptoms and a risk of significant bone loss (osteoporosis) if used for more than six months.

Can Fibroids turn into cancerous if untreated?

Uterine cancer caused by fibroids is extremely rare, usually occurring after the woman goes into menopause in their fifties and sixties. Virtually all premenopausal women with growing fibroids have benign uterine fibroids. However, if a patient is postmenopausal and does not take estrogen, any growth of the uterus is an indication for surgery.

What is myoma coagulation (myolysis)?

Myoma coagulation, or sometimes called myolysis, is a laparoscopic procedure developed to shrink fibroids without removing them. The procedure is performed through a laparoscope and uses either a laser or electrical or cryo needle that is passed directly into the fibroid to destroy both the fibroid tissue and the blood vessels feeding it. The destroyed fibroid tissues do not require removal as they will be absorbed slowly by the uterus. At the present time, myoma coagulation is not recommended for women who want to have children, due to scar tissue formation that most likely will weaken the strength of the uterine wall. Because of the potential risk of the uterus tearing during labor, the standard recommendation for patient who have undergone myolysis is that they do not attempt to get pregnant afterwards.

What is uterine artery embolization procedure for the treatment of fibroids?

Uterine artery embolization is a fairly new procedure developed to shrink fibroids without surgical removal of them. The procedure, performed by an interventional radiologist, involves injecting the embolizing agent to both uterine arteries (blocking the main blood supply to the uterus), producing temporal ischemic change (low blood flow, thus low oxygen saturation) to the entire uterus, including fibroids, thereby causing degeneration (death) of the fibroids. Compared to normal uterine cells, fibroid cells are much more sensitive to low oxygen saturation, resulting in quick death in a low oxygen environment. When the main blood supply to the uterus is diminished greatly by blocking both uterine arteries with embolizing agent, the normal uterine tissue will continue to survive but not the fibroids, which will die and eventually be absorbed by the uterus. The problem arises when the patient has large volume of degenerated (dead) fibroid tissue within the uterus, which can cause some degree of swelling in the lower abdomen of some patients. Most of patients will experience fever, malaise, pain (sometimes severe), and discomfort. Because of the potential risk of damage to the endometrium (lining of the uterine cavity) and possible uterine rupture during labor, we advise that women not attempt to get pregnant after they have had the uterine artery embolization procedure.