Myomectomy and Types Myomectomy...!!

A myomectomy is a surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later.

There are 3 main types of Myomectomy procedures:

1. Hysteroscopic myomectomy
In this procedure, a camera is introduced through the vagina and into the uterine cavity. Submucous or intracavitary myomas are easily visualized and can be resected or removed using a wire loop or similar device. While submucous myomas can cause significant bleeding and anemia, their management is straightforward with hysteroscopic myomectomy. Patients usually are sent home after surgery and have minimal need for recovery.

2. Open myomectomy
Now reserved for patients with very large myomas, an open myomectomy is traditional surgery involving an incision similar to a cesarean section incision. The fibroids are shelled out from the normal uterus and the uterus is repaired using multiple rows of suture. Patients normally are hospitalized for 1-3 days and experience discomfort similar to other open surgeries. Most patients are able to return to work in 4 weeks comfortably.

3. Laparoscopic or Robotic myomectomy
During this procedure, a 10 millimeter (1 centimeter) camera is introduced, usually through the umbilicus or belly button. Three other small (5 - 8mm) incisions are made and instruments are used to complete the surgery similar to an open myomectomy. This procedure is more time consuming, and technically difficult but affords the patient a more rapid recovery. In our practice, patients are observed in the hospital overnight and usually released in the morning. They typically return to work in 2-4 weeks.
The da Vinci robotic system has revolutionalized laparoscopic myomectomy, allowing for improved suturing of the uterus with better visualization.
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