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Hysteroscopic Myomectomy / PolypectomyA myomectomy is a procedure to remove fibroids from your uterus performed by your gynecologist. Fibroids are benign muscular growths on the inside, in the walls, or outside your uterus. Your gynecologist may perform this procedure in several different manners. These include hysteroscopic myomectomy (with a tiny camera), open technique, also called a laparotomy (with the assistance of a robot), or laparoscopic myomectomy (with small cameras but through the abdomen) if you have abnormal bleeding patterns that may or may not be accompanied by infertility issues as well. Broken down:

  • A hysteroscopy is a process of looking into your uterus with a tiny camera instrument called a hysteroscope.
  • Myomectomy means the removal of myomas (fibroid growths inside or on the uterus).
  • Polypectomy removes polyps (benign growths, like skin tags, on the inside of the uterus).

Whether you have a myomectomy vs. hysterectomy will result in very different outcomes. The myomectomy removes only fibroids; your uterus remains entirely intact. Hysterectomy involves the doctor entirely or partially removing your reproductive organs, including your fallopian tubes, ovaries, and womb. One of the main reasons to get a hysteroscopic myomectomy/polypectomy is determining which procedure you need.

Size and location are the two most important considerations when deciding how to address a fibroid.

Are There Any Risk Factors?

Suppose your symptoms don’t respond to more conservative treatments. In that case, you may be a candidate for hysteroscopic myomectomy/polypectomy and at risk for uterine polyps or fibroids that lead to abnormal bleeding.

Other reasons to undergo the procedure include if you:

  • Are on tamoxifen therapy for breast cancer treatment
  • Have had polyps in other reproductive organs
  • Have chronic bleeding following sex
  • Experience continuous, chronic vaginal discharges
  • Have dysmenorrhea  or abnormally painful menstrual cycles
  • May have polyps that are preventing you from getting pregnant

How to Prepare for the Test?

While the procedure is minimally invasive, your doctor may put you under general anesthesia for abdominal, robotic, laparoscopic, and other types of hysteroscopic myomectomies. Conversely, you may receive a localized spinal anesthetic that numbs the lower half of your body. Doctors commonly use spinal anesthesia with certain hysteroscopic myomectomies.

If your gynecologist decides on general anesthesia, you can expect to be out for about 15 to 30 minutes. The specialist will ask you to stop eating and drinking at least 12 hours before your procedure. Additionally, tell your gynecologist about any medications you may be taking, including herbs, supplements, and other over-the-counter medications, such as vitamins and pain relievers. You’ll most likely need to discontinue their use until after the procedure. It is essential to tell your doctor if you are taking any blood pressure medications, blood thinners, diabetes drugs, or seizure medications before scheduling the procedure or surgery.

While a hysteroscopic myomectomy/polypectomy is typically an outpatient procedure, your doctor may admit you to a hospital for it.

  • An open myomectomy, performed through your abdominal cavity, usually requires a two to three-day hospital stay.
  • A robotic myomectomy or one done with a laparoscopic usually requires just an overnight stay.

What Is the Difference Between Laparoscopic Myomectomy and Abdominal Myomectomy?

Whenever possible, your gynecologist will choose the least invasive procedure, which in this case is the laparoscopic myomectomy. It requires only a tiny incision, made near your navel, through which your surgeon inserts a long, thin tube with a light and a camera on end. Your doctor will then insert another one through the first tube. That one holds the instruments that do the fibroid scraping.

On the other hand, an abdominal myomectomy, also called a laparotomy, requires a more extensive incision made across your abdomen to access your uterus. This procedure gives your Midtown gynecologist greater access to view your uterus and remove large fibroids.

Risks for both kinds of procedures include:

  • Excessive loss of blood
  • Adhesions on the outside wall of your uterus that could lead to further complications
  • Weakening of your uterine walls could cause complications during a future pregnancy.
  • The rare chance that you may have to have a hysterectomy if bleeding occurs that can’t be stopped.

What to Expect from Vaginal Myomectomy?

vaignal myomectomy Once you’ve been prepped and moved into a surgical suite in our women’s health center or hospital:

  • Your cervix is dilated with a sterile saline solution to expand the area and give the surgeon room to inspect your reproductive organs visually.
  • Tissue is cut, usually with a laser through your vagina and your uterus into the cervix, to retract it appropriately.
  • Your doctor shaves off the pieces of the fibroids to make them even with the rest of the tissue lining your cervix.
  • Polyps are entirely removed, with a sharp pincer-type instrument attached to a long, thin, lighted tube. The specialist may lightly cauterize the area to stop any bleeding.
  • Once your doctor removes the instruments, they will lightly rinse your cervix with the fluid used to expand it. Rinsing helps wash out excess tissues from the fibroids.

Once you leave the office or hospital, your doctor will prescribe you a mild pain reliever. Follow the directions for after-care that you receive, such as:

  • Resume normal eating habits immediately
  • Avoid tampon use for at least two or three days
  • Refuse sexual intercourse until all the bleeding has stopped completely
  • Only take showers, no baths, until the bleeding has completely stopped
  • Use a hot water bottle or pain medication when you feel uncomfortable cramping, which is to be expected for a few days
  • Plan to avoid driving for at least 24 hours
  • Get back into your normal daily routines as soon as you feel able unless your doctor advises you otherwise.

Are There Any Complications After the Hysteroscopic Myomectomy?

Your gynecological surgeon must remove all polyps found because those tend to be the culprits that lead to cancer. Removing benign polyps is an essential step in decreasing any signs of cancer early on.

Complications from the procedure are rare, but they do exist. Some potential side effects of myomectomy/polypectomy include:

  • Excessive bleeding after the procedure. This issue might be particularly prevalent if the reason for the treatment in the first place was heavy bleeding. While your gynecologist Midtown takes extra precautions to prevent excess bleeding, they may direct you to take steps to build your blood count up before the procedure.
  • A hysteroscopic myomectomy may affect a future pregnancy if any incisions made during the procedure weaken your uterine walls. You may have to undergo a cesarean section or C-section to avoid further complications. Additionally, the very presence of uterine fibroids is often associated with complications during pregnancy.
  • Scar tissue sometimes forms at the site of the surgical incision. Scar tissue forming outside the uterus can lead to a blocked fallopian tube or problems with your intestines becoming looped. Adhesions rarely form inside the uterus, but you could develop Asherman’s syndrome, which causes infertility if they do.
  • Hysterectomy is another infrequent complication. It results from finding severe abnormalities in your uterus or if bleeding becomes uncontrollable while having the procedure done.
  • Cancerous tumors can be spread during this procedure, although this too is a rare complication. It’s more common in post-menopausal women. It results from tumors mistaken for fibroids and shaved into tiny pieces that travel through your body and multiply.

How Long Is the Recovery Time and When To Expect the Outcomes?

Following a myomectomy, you may feel fatigued and experience higher pain levels for a couple of days. After a laparoscopic procedure, you should be able to walk out of the hospital on your own on the first day. You’ll be back driving in a few days, back to work as soon as you feel ready, and back to your regular exercise routines within about two weeks. If your doctor performs the procedure abdominally, you might have to spend the first night in the hospital.

Long-term, your recovery time varies depending on your age and general health. Still, it generally takes about two weeks of rest and up to six weeks of slow recovery time following an abdominal myomectomy. You should see your Midtown gynecologist if you have continual bleeding from either procedure.

Are There Any Valuable Outcomes?

The results from a hysteroscopic myomectomy/polypectomy can lead to drastic improvements in your life. At the same time, once you’ve had fibroids or polyps, you are at a greater risk of getting them again.

Immediate benefits include:

  • Improved fertility. While your chances of a post-hysteroscopic myomectomy pregnancy are greatly improved, you should wait about three months before trying to get pregnant to give your uterus sufficient time to heal fully.
  • Relief from the symptoms These include ones that instigated the procedure in the first place, such as excessive bleeding that finally comes under control.

All symptoms should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any serious underlying condition. You should always discuss the hysteroscopic myomectomy procedure, indications, options, and risks/benefits with your gynecologist.

Fibroids very rarely turn into cancer but can still interfere with daily activities.

Have questions about Hysteroscopic Myomectomy / Polypectomy procedure? Schedule an appointment with an internationally recognized NYC OBGYN doctor today.

Updated on Sep 23, 2023 by Manhattan Women’s Health and Wellness
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