Removal of Fibroids
Myomectomy is an operation to remove fibroid tumours (myomas) from the uterus. This retains the uterus, and is an alternative treatment to hysterectomy. It is sometimes a more difficult operation than hysterectomy but preserves reproductive choice for the patient.
Advantages of laparoscopic myomectomy
- Small incisions and less scarring
- Gentler handling of the body tissues and organs during the operation
- Less postoperative pain
- Less postoperative narcotic use for pain relief
- Shorter hospitalisation
- Faster overall recovery with an earlier return to normal activity
How does laparoscopic myomectomy work?
Preoperative preparation involves a shave and a small enema, and you will need to fast for six hours before the operation.
- A general anaesthetic is administered.
- The laparoscope and other instruments are introduced – see laparoscopic surgery for more details.
- The fibroid is visualised. A cut is made in the uterus and the fibroid is freed from the uterine muscle.
- The incision in the uterus is repaired with sutures.
- The fibroid is removed, usually by cutting it up into small pieces to get it out of the small incisions.
- The wounds are closed.
Recovery after fibroid removal
Immediate post-operative recovery involves an average of two days in hospital. A fifth of patients can go home late the next day after surgery, and about 80% patients are home in two days. Patients are welcome to rest in hospital for as long as they need to.
One in five patients will only need tablets and not injections for postoperative pain relief. If injections are required about two are needed on average. Patients will be given as much pain relief as they request to make sure they are comfortable.
A low-grade temperature is common in the first few days after surgery. The first few days at home should be taken very easily. The patient should have someone to help. Plenty of rest and fluids are advisable. Exercise your calf muscles to prevent clots. Oral pain relief such as Panadeine or Panadol may be needed, especially at night.
Graded recovery over the next few weeks will occur. Gentle increasing exercise is helpful. Driving is permissible. Expect to tire easily. Bowel discomfort and some cramps are common. Return to normal activity occurs at about 2-3 weeks for many patients. All patients should individually assess their recovery rate. Some may need more time off work than others and certificates will always be provided. It is important not to have sexual intercourse for six weeks after the operation.
Risks of myomectomy
These risks apply to myomectomy, no matter which method is used to approach the uterus.
Infection. Infection rates are low as preventative antibiotics are used at and after the surgery. In hospital rates are 1-2%.
Bleeding. At the time of the operation some blood will be lost. Rarely this can be serious and require some emergency treatment such as transfusion.
Damage to bowel, bladder and ureter. These structures are very close to the uterus and can be damaged as the fibroid is removed. The risks are about 1 in 250-300 cases. Damage detected at the time of surgery is repaired immediately and will often not have serious consequences. Sometimes the injury can be undetected or develop over several days after surgery, such as where a burn is made to stop bleeding.
Deep Venous Thrombosis or Pulmonary Embolus. A clot can form in the leg or pelvic veins and travel to the lungs. The complication will happen in about 1 in 400-500. This is serious and can rarely be fatal. Tell your doctor if this has happened to you before or if you have a family history. During the surgery a number of precautions are taken to prevent these conditions. Early mobilisation after laparoscopic surgery may also reduce the risk compared to larger incision operations.
Other risks of laparoscopy – As described in the page on Laparoscopic Surgery.
Conversion to open myomectomy. During the course of the operation the doctor may decide your case is not suitably safe for a laparoscopic approach. A conventional myomectomy as could be done elsewhere will then be performed. The risk of this is 10 in 100 cases.
Adhesions (scarring) are a common complication of myomectomy. These may stick to tubes, ovaries, bowel and uterus. They can cause pain or infertility. They may be reduced by performing another laparoscopy to free them up 10 to 14 days post surgery.
Uterine rupture in pregnancy can occur if the scar in the uterine wall gives way in labour. Caesarean Section is often the safest mode of delivery after large fibroids have been removed from the uterus.