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Other alternatives to myomectomy.

Uterine artery embolisation:

This is an angiographic procedure in which the blood supply of the fibroid is blocked so that the fibroids shrink. This method is popular in the west but is not so popular in India due to its several disadvantages, high cost and minimal advantages over other methods of treatment.

 

HIFU:

This is High Intensity Focused Ultrasound. This method uses focused ultrasound to destroy the fibroid. This method is expensive and has a high rate of fibroid recurrence.

 

When is a myomectomy recommended?

The common indications are infertility, excess pain, excess menstrual bleeding and other pressure symptoms like difficulty in passing urine or heaviness in the lower abdomen.

 

Myomectomy may also be needed in a case of recurrent miscarriage (recurrent pregnancy loss) and repeated pre term births due to fibroids.

 

What are the different methods of myomectomy?

Myomectomy can be done by open method or by laparoscopy.

In the open method (laparotomy), the abodomen is opened through a small incision and the uterus is reached. The fibroid or fibroids are located and an incision is placed on the uterus to reach the fibroid(s). The fibroid or fibroids are enucleated and the fibroid bed is sutured. The uterus is thus repaired and conserved.

 

In a laparoscopic myomectomy, the uterus is reached through small key holes on the abdomen. These key holes heal well leaving almost no scar and are relatively painless. Once the uterus is reached, the procedure for myomectomy is the same as in the open procedure. The uterus is repaired after the laparoscopic myomectomy using sutures. The fibroid is then morcellated (cut into small pieces) and delivered through the small abdominal incisions.

 

For relatively small myomas which are located deep inside the uterus, hysteroscopic myomectomy is recommended. In this method, the myoma is removed under vision using a small instrument through the vaginal route. This method avoids cutting the uterus and abdomen. This method can only be used in selective cases and depends largely on the location and size on the fibroid.

What is myomectomy?

This is a conservative surgery of the uterus in which only the fibroid (myoma) is removed from its surrounding uterine tissue. The uterus is sutures and repaired. This surgery preserves the intact uterus and is a good option for women with fibroid uterus who want future pregnancies.

 

What are fibroids and their type?

Fibroid is the commonest benign solid tumor of the uterus. (Benign means non-cancerous tumor).

It is also called uterine leionmyoma, myoma or fibromyoma.

Types of fibroids:

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What to expect before the operation?

The patient undergoes routine blood and urine tests before the surgical procedure and her fitness is assessed. Some patients with fibroids frequently have low hemoglobin (less blood) due to prolonged and heavy menstrual blood loss. This blood loss needs to be corrected before surgery.

The surgery is usually very comfortable and painless for the patient. With the modern methods and medicines, the risks of this procedure are far lesser than what the used to be some fifty years back.

 

What to expect after the operation?

After the surgery, most patients are mobile and independent within 24 – 48 hours. Pain felt is minimal and most household activities can be performed by the patient within one week. Patient is advised not to do heavy weight lifting and sexual intercourse for six weeks.

 

When to meet the doctor after the myomectomy operation?

Most patients are advised to meet the doctor after fifteen days for a general examination.

 

Important points to remember after the surgery.

Patient is counseled to plan the next pregnancy after 6 – 12 months gap after myomectomy.

ough the small abdominal incisions.

 

For relatively small myomas which are located deep inside the uterus, hysteroscopic myomectomy is recommended. In this method, the myoma is removed under vision using a small instrument through the vaginal route. This method avoids cutting the uterus and abdomen. This method can only be used in selective cases and depends largely on the location and size on the fibroid.