Myomectomy

What is a Myomectomy?

Myomectomy is a surgical procedure aimed at removing uterine fibroids (also known as myomas), which are non-cancerous growths that develop in the muscular wall of the uterus. This procedure is distinct from a hysterectomy, where the entire uterus is removed. Myomectomy is often chosen by women who wish to retain their uterus for various reasons, including the desire to maintain fertility or for personal and psychological reasons.

Common Names for Myomectomy

Myomectomy is the medical term for the surgical removal of uterine fibroids. Some other common names for this procedure include:

• Fibroid removal surgery
• Uterine fibroid surgery
• Fibroidectomy
• Uterine myomectomy
• Leiomyoma resection
• Myoma resection

Who is Suitable for a Myomectomy?

Myomectomy is typically recommended for women with symptomatic uterine fibroids who wish to preserve fertility. It may be suitable for women who experience heavy or prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, or difficulty becoming pregnant.

The following factors are considered when determining if myomectomy is suitable for a patient:

• Size, location, and number of fibroids
• Patient's age and overall health
• Patient's desire to have children
• Patient's preference for preserving the uterus
• Feasibility of the procedure based on the location of the fibroid

Myomectomy is not recommended for women with cancerous growths in the uterus or those who have completed their childbearing and wish to undergo a hysterectomy. 

Benefits of Myomectomy

Myomectomy offers several benefits for women who have symptomatic uterine fibroids and wish to preserve their fertility:

• Symptom Relief: Effective in alleviating symptoms associated with fibroids, including heavy menstrual bleeding, pelvic pain, and pressure symptoms.
• Fertility Preservation: Unlike hysterectomy, myomectomy preserves the uterus, offering women the possibility to conceive in the future.
• Psychological Benefits: Retaining the uterus can have positive psychological effects on women who value their reproductive organs.

Types of Myomectomy

The type of Myomectomy depends on the size and site of the fibroid. There are several types of Myomectomy. These include:

• Abdominal Myomectomy (Laparotomy): Involves making a large incision in the abdomen to access and remove fibroids. Suitable for larger or multiple fibroids.
• Laparoscopic Myomectomy: Involves making small incisions in the abdomen and using a laparoscope to remove fibroids. This minimally invasive technique is suitable for smaller and fewer fibroids.
• Hysteroscopic Myomectomy: Involves inserting a hysteroscope through the vagina and cervix into the uterus to remove fibroids that are located inside the uterine cavity. This method is suitable for submucosal fibroids.
• Robotic Myomectomy: Utilises robotic technology to assist in the laparoscopic removal of fibroids, offering enhanced precision and control.

Alternative Options to Myomectomy

There are several alternatives to a myomectomy for treating symptomatic uterine fibroids, including:

• Hysterectomy: A hysterectomy is the surgical removal of the uterus. This is the most effective treatment for fibroids, but it is also the most invasive, and it makes the patient unable to have biological children.
• Uterine artery embolisation (UAE): This minimally invasive procedure blocks the blood flow to the fibroids, causing them to shrink. It's a good option for women who don't want to have surgery and have completed their childbearing.
• Medications: Certain medications, such as Gonadotropin-releasing hormone (GnRH) agonists, can shrink fibroids, but they are not a permanent solution and can have side effects. 
• Watchful waiting: Watchful waiting may be suitable for women with mild or moderate fibroids who are not causing symptoms. They will be monitored for changes to the fibroids and symptoms over time.

What to Do Before a  Myomectomy?

• Consultation: Discuss the procedure, potential risks, and benefits with your gynaecologist.
• Preoperative Tests: Undergo necessary preoperative tests such as blood tests, imaging studies (ultrasound or MRI), and possibly a hysteroscopy.
• Medication Management: Follow instructions regarding medications, including stopping blood thinners or hormonal treatments if advised.
• Lifestyle Adjustments: To optimise your health before surgery, maintain a healthy lifestyle, including a balanced diet and regular exercise.

Myomectomy Procedure

• Anaesthesia: The procedure is performed under general anaesthesia.
• Surgery: The type of myomectomy performed will determine the surgical approach. The surgeon will access the uterus, remove the fibroids, and repair the uterine wall.
• Duration: Depending on the complexity, the procedure typically takes 1 to 3 hours.

What to Expect After Myomectomy?

• Recovery Time: Recovery time varies depending on the type of myomectomy. Abdominal myomectomy may require a hospital stay of 1 to 2 days and a recovery period of 4 to 6 weeks. Laparoscopic and hysteroscopic myomectomies typically have shorter recovery times.
• Pain Management: Pain and discomfort are common post-surgery, and pain relief medications will be provided.
• Activity Restrictions: A gradual return to normal activities is advised. For several weeks, avoid heavy lifting and strenuous activities.
• Follow-Up: Regular follow-up appointments are necessary to monitor healing and address concerns.

Myomectomy Recovery Plan

• Rest: Adequate rest is crucial for recovery. Gradually increase activity levels as tolerated.
• Diet: Maintain a balanced diet to support healing. Stay hydrated and include fibre-rich foods to prevent constipation.
• Exercise: Gentle walking is encouraged to promote circulation. Avoid intense physical activity until cleared by your doctor.
• Monitoring: Watch for signs of infection or complications, such as fever, excessive bleeding, or severe pain, and contact your healthcare provider if they occur.

Myomectomy Prognosis

Most women experience significant relief from fibroid symptoms after myomectomy. The procedure's success in terms of symptom relief and fertility enhancement is generally high. However, fibroids can recur, and ongoing monitoring is important.

Myomectomy Risks

• Bleeding: Significant blood loss during surgery, sometimes necessitating a blood transfusion.
• Infection: Risk of infection at the surgical site or internally.
• Scarring: Formation of scar tissue (adhesions) in the pelvis.
• Uterine Rupture: In rare cases, the uterus may rupture in future pregnancies, particularly if the uterine wall was extensively repaired.
• Recurrence: Fibroids may recur, requiring additional treatment.

What if Myomectomy is Delayed?

Delaying myomectomy can lead to:

• Worsening of symptoms, including increased pain and bleeding.
• Progressive growth of fibroids, making future surgery more complex.
• Potential impact on fertility, especially if fibroids interfere with the reproductive organs.
• Increased risk of complications such as anaemia due to heavy menstrual bleeding.

Cost of myomectomy

• Public Healthcare (Medicare): If performed in a public hospital, many costs are covered by Medicare, but there might be out-of-pocket expenses for some patients, especially if there are additional tests or treatments.
• Private Healthcare: For those with private health insurance, a significant portion of the costs is usually covered. However, patients might still have out-of-pocket expenses, including:
• Surgeon’s Fees: Depending on the complexity of the procedure, these can range from AUD 500 to AUD 2,000+.
• Hospital Fees: Depending on the hospital and the length of stay, this can range from AUD 1,000 to AUD 3,000+.
• Anesthetist’s Fees: Anaesthesia costs range from AUD 500 to AUD 1,500+.

It's advisable to check with individual healthcare providers and insurance companies for precise costs and coverage details.