Removal of fibroids - MYOMECTOMY

Myomectomy is a surgical procedure to remove the fibroids, without removing the uterus. Depending on the size and location of the fibroids, they can be removed in different ways, as described below. While open surgery is the most common form of myomectomy done , because of our expertise in minimally invasive surgery, we have replaced this with laparoscopic or hysteroscopic myomectomy for most of our patients.

Hysteroscopic Myomectomy

It is also known as hysteroscopic resection of fibroid. It is suitable for fibroids that occur on the inside (cavity) of the uterus. These fibroids are removed using a fine, slender instrument called hysteroscope. Operative hysteroscopy is a form of endoscopic surgery performed by minimally invasive surgeons.

Open Abdominal Myomectomy

This is the conventional way of removing fibroids from the abdomen – and it is the most common route of myomectomy performed. The fibroid is removed via a large incision on the abdominal skin (laparotomy). The incision can be horizontal (a bikini line incision) or vertical from just below the navel to pubic bone. Complete recovery typically takes 4-6 weeks.

Our specialized procedure - Laparoscopic (keyhole) Myomectomy

Instead of a large bikini line incision, our minimally invasive surgeon makes only small incisions (typically 0.5 – 1.5cm) on the abdomen and uses laparoscopic instruments to remove the fibroid.

Compared to open myomectomy, minimally invasive surgery gives the advantages of less pain, infection, and scarring, as well as quicker return to normal activities.

As laparoscopic myomectomy for a big fibroid is considered as a technically challenging procedure, it is only offered by surgeons equipped with advanced laparoscopic skills. In particular, the surgeon have to repair the uterus confidently with precise surgical sutures using laparoscopic techniques. If the fibroid is exceptionally large or deeply embedded in the uterus, it may not be feasible to be removed laparoscopically.

Special concerns of myomectomy

Myomectomy is an effective way to remove fibroids and it brings good outcomes in treating fibroid-related problems. However, there are some special concerns that a woman need to consider when deciding on myomectomy.

• Bleeding during the operation - The risk is especially higher if there are multiple fibroids to be removed. There are blood vessels connecting the fibroids and the uterus tissue. Separating a fibroid from the attached tissue can often cause more bleeding than a hysterectomy .
• Eventual re-growth of fibroids - The younger the patient, the higher a chance that other fibroids may grow from the uterus again before reaching menopause.
• Special precaution in pregnancy – It is advised woman to have Caesarean section delivery for pregnancies in the future.

This is because of the risk of rupture of the myomectomy scar on the uterus when the woman goes into labour.

Because of these concerns, if the woman no longer plan to get pregnant in the future, hysterectomy will offer a permanent solution and definitive cure to her fibroid problems.