This is an operation to remove the fibroids from the uterus.
The myomectomy can be performed in several different ways:
The Laparoscopic Myomectomy allows the fibroids to be removed through small incisions in the abdomen. In a first step, the abdomen is filled with air to create a larger space (rather like a balloon). Next, one or more incisions of about 1 cm are made in order to insert the instruments.
The fibroid is then removed and the uterus is sutured. A morcellator is used to extract the fibroid from the abdominal cavity.
One of the factors that most influences postoperative pain, the risk of infection and the recovery and return to normal life is the size of the incisions made in the body.
The very small incisions made in laparoscopic abdominal myomectomy mean better recovery and overall results.
However, not all fibroids can be removed by laparoscopic surgery. Some require larger abdominal incisions. Nevertheless, there is no hard rule on the maximum size or eligibility of patients to be candidates for this type of myomectomy. It depends largely on the team’s experience.
As with any invasive procedure, the risk of infection, haemorrhage or to other organs (intestines, urinary tract, etc.) must be taken into account. These occurrences are rare, but they can happen.
The Hysteroscopic Myomectomy consists of the removal of the fibroids by endoscopy, thanks to the introduction of a hysteroscope through the vagina and the cervix.
The walls of the uterine cavity are separated by the introduction of a liquid. A visual inspection is performed by guiding the hysteroscope through the inside of the uterus and then the specialised surgical instruments are inserted through the hysteroscope channel to operate on the fibroids.
The procedure is performed under local or regional anaesthetic, with or without sedation.Despite being a minimally invasive operation, a number of complications may occur: vaginal bleeding, pain, gynaecological infection, perforation of the uterus (in exceptional cases the resectoscope may damage the abdominal viscera, bowel, bladder or blood vessels) and circulatory overload due to Glycine absorption.
This procedure is indicated for small (3-4 cm) submucosal fibroids of type 0 (located within the uterine cavity) and type 1 (which only penetrate slightly into the myometrium thickness).
This type of Abdominal Myomectomy involves the removal of the fibroids by traditional surgical methods.In the event that no less-aggressive technique can be used, then a larger incision has to be made in the abdomen.
Depending on the size or the location of the fibroids, either a phannenstiel-type incision may made (like a Caesarean section) or a midline incision. However, there is an increasing tendency to use less extensive incisions to lessen the impact of our actions on the body.
Whereas at one time incisions measuring 15 cm to 20 cm were made, nowadays we perform the myomectomy with incisions of less than 5 cm, and we obtain better results.
In the event that surgery has to be performed, whether laparoscopic or open-surgery, our team uses a tailored intraoperative ultrasound which allows fibroids measuring less than 1 cm to be located, thereby ensuring removal of the greatest number of fibroids and optimal anatomical reconstruction of the uterus.