Myomectomy is a surgical procedure that’s employed to remove fibroids in your uterus, also called leiomyomas. These usually are non-cancerous, but removing them can eliminate certain symptoms you may be having. When it’s performed laparoscopically, the procedure is done with a fiber-optic instrument that makes it minimally invasive.
The main difference between a myomectomy and a hysterectomy is that in the former, the womb is left intact, whereas it’s removed in the latter. A hysterectomy, as a matter of fact, is the very definition of removing your uterus partially or in its entirety, making it impossible to conceive.
Why You May Need the Procedures
If you are young enough and would like to have more children (or even your first child), then it’s usually recommended that you undergo a myomectomy first to try to relieve your symptoms. With the laparoscopic procedure, you face fewer risks of infertility. Your doctor’s only looking for small fibroids that could be causing:
- Chronic constipation
- Heavier than normal menstrual cycles
- Bleeding during your periods that lasts longer than a week
- Pelvic pain or pressure
- Leg pain or backaches
- Urinating more frequently
- Difficulty starting a urine stream
On the other hand, a hysterectomy may be the best form of treatment for more serious conditions, such as:
- Cancer, including ovarian, cervical or endometrial
- Uterine prolapse, when your uterus falls out of place
- Adenomyosis, when endometrial tissue moves outside of your uterus
- Severe endometriosis that hasn’t responded to other treatments
- Uncontrolled bleeding while giving birth
- Chronic pelvic pain
- Vaginal bleeding that continues despite various treatments
- Fibroids, which could be uterine tumors
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 underlying serious condition.
Hysterectomy is the second most common surgery performed in the U.S., accounting for about 556,000 operations every year. Depending on your age, severity of your symptoms and future lifestyle plans, you and your OBGYN can decide which hysterectomy option is best for you. Some options are:
- A radical hysterectomy removes all of your reproductive organs. It’s usually performed when you’ve been diagnosed with cervical or endometrial cancer.
- During a partial hysterectomy, only your uterus is taken out. A laparoscopic myomectomy may be performed on the rest of your organs to remove fibroids.
- A total or simple hysterectomy removes just your uterus and cervix. It’s ideal for women with fibroids who don’t want to lose their ovaries.
- Laparoscopic hysterectomy is the most minimally invasive procedure, but it’s not recommended if your doctor suspects cancer. “Laparoscopic hysterectomy cancer” are three words you don’t want to hear together.
Laparoscopic Myomectomy vs Abdominal Myomectomy
Whenever possible, your doctor should choose the least invasive procedure, which in this case is the laparoscopic myomectomy. It requires only a tiny incision, made near your navel, though which your surgeon inserts a long, thin tube with a light and a camera on the end. Another tube is then inserted 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 that a larger incision be made across your abdomen to access your uterus. This procedure gives your doctor 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 that 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
Hysterectomy Procedure and Risks
There are a number of avenues your surgeon may take to perform your hysterectomy, depending on your goals, as well as your doctor’s preferences. Removing your reproductive organs may be done by:
- A cut made surgically in your vagina
- Three or four smaller incisions made through your belly, usually reserved for robotic hysterectomy
- A larger cut made in your abdomen
- Smaller cuts around your navel for laparoscopic removal
In addition to the normal risks associated with any surgical procedure, hysterectomy complications can include:
- Sex after hysterectomy can be painful
- Bladder or ureter injuries
- A loss of sexual interest or appetite
- Menopausal symptoms if your ovaries were removed
- Higher risk of heart disease if your ovaries are removed before natural menopause
Myomectomy Recovery Times and Outcomes
Following a myomectomy, you may feel fatigued and experience higher pain levels for a couple 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 day, back to work as soon as you feel ready and back to your normal exercise routines within about two weeks. If the procedure was performed abdominally, you may have to spend the first night in the hospital.
Long-term, your recovery time varies depending on your age and general health, but generally, it takes about two weeks of rest and up to six weeks of slow recovery time following an abdominal myomectomy. You should see your doctor if you have continual bleeding from either procedure.
After an abdominal or vaginal hysterectomy, you’ll be encouraged to get up and walk as soon as you wake from the anesthesia. After one or two days in the hospital, you’re sent home to monitor yourself for pain and excessive bleeding. You’ll leave with medication to prevent infection and relieve your pain. Expect to be back to normal in about four to six weeks.
Following a laparoscopic hysterectomy, you can expect many of the same side effects, but your recovery time is much quicker, typically from one to two weeks.
One of the most glaring differences between an abdominal (the most common) and a laparoscopic (the least invasive) hysterectomy is the scarring you’re left with. Laparoscopic hysterectomy scars are virtually non-existent. The tiny incisions heal quickly and leave no visible reminders. The abdominal hysterectomy scar heals, but is bigger. Your surgeon places it so that it falls in natural folds on your belly, but you most likely will have a visible scar.
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 underlying serious condition. Laparascopic myomectomy/hysterectomy, indications, options, risks/benefits should always be discussed with your gynecologist.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.
Do you have questions about Laparoscopic Myomectomy/Hysterectomy procedure? Would like to schedule an appointment with internationally recognized OB GYN doctor, Dr. Pedram Bral of Manhattan Women’s Health and Wellness, please contact our office for OBGYN consultation.consultation.
Dr. Pedram Bral, Gynecologist (Gynecologist NYC, Midtown)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4575