Removal of fibroids, which are non-cancerous tumors, from the wall of the uterus.
Parts of the Body Involved
Uterus
REASONS FOR PROCEDURE
To relieve problems caused by fibroids without having to perform a hysterectomy (removal of the uterus). These problems include:
- Pelvic pain
- Back pain
- Pressure on the bladder
- Abnormal uterine bleeding (often leading to anemia)
- Difficulty becoming pregnant
- Discomfort during sexual intercourse
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
- Stress
- Obesity
- Chronic or recent illness
- Excessive use of alcohol
- Smoking
- Use of narcotics or other mind-altering drugs
- Use of certain prescription medications, including muscle relaxants and sedatives, anti-hypertensives, insulin, beta-adrenergic blockers, blood-thinning medications, and cortisone
- Diabetes
WHAT TO EXPECT
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Review of medications
- Blood studies
- D&C – surgical removal of tissue from the lining of the uterus (endometrium) to diagnose or treat gynecologic or obstetric conditions
- X-rays of abdomen
- Barium-enema x-rays – a series of x-rays taken after a barium-containing substance is injected through the rectum
- Intravenous pyelogram – x-rays taken of the kidneys, ureters, and bladder after injection of a contrast medium into a peripheral vein
You should discuss the following with your doctor:
- The possibility that signs of malignant cancer may be found in the uterus during surgery and what action you would like the doctor to take if this is the case. One option is removal of the uterus during this procedure. (Approximately 1 in 200 women with fibroids are found to have malignant uterine cancer.)
- If you should consider hormone treatment for 2-4 months before surgery. This treatment shrinks fibroids, making removal easier and reducing the risk of excess blood loss during surgery.
- If you should consider banking your own blood before surgery, due to the risk of excess blood loss during surgery.
- In the days leading up to your procedure:
- Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (such as ibuprofen) for one week before the procedure
- Arrange for a ride to and from the procedure
- Do not eat or drink for at least 8 hours before the procedure
During Procedure – Anesthesia, bladder catheter
Anesthesia:
Open surgery - General anesthesia given via injection and inhalation
Laparoscopic surgery - General anesthesia given via injection and inhalation or local anesthesia
Description of the Procedure - There are a number of methods for removing fibroid tumors from the uterus. The two most commonly used are open surgery and laparoscopic surgery.
Open surgery - A catheter is inserted into the uterus, and a blue dye is injected to stain the uterine cavity and help make location of the fibroid(s) easier. One or more incisions are made in the lower abdomen. Muscles are separated and connective tissue is cut to expose the uterus. When a fibroid is located, it is surgically removed. In some cases, Pitressin, a drug that causes the blood supply to stop for up to 20 minutes, is first injected into the fibroid to reduce bleeding when it is removed.
After each fibroid is removed, special care is taken to stitch each layer of tissue in the uterus in order to prevent blood clots, excessive bleeding, and infection. Once all fibroids are removed, surgical tools are removed, the abdominal muscles are sewn together with heavy stitches, and the incision is closed either with stitches or clamps.
Laparoscopic surgery - A catheter is inserted into the uterus, and a blue dye is injected to stain the uterine cavity and help make location of the fibroid(s) easier. A small incision is made in the navel, and a laparoscope is inserted into the uterus. A laparoscope is a specialized endoscope, which is fiberoptic tube attached to a viewing device, used to examine the abdomen.
Two or three additional small incisions are made in the abdomen through which special laporoscopic tools can be inserted. Using the laporoscope, the surgeon locates each fibroid and surgically removes it. In some cases, Pitressin, a drug that causes the blood supply to stop for up to 20 minutes, is first injected into the fibroid to reduce bleeding when it is removed. After removal of each fibroid, special care is taken to stitch each layer of tissue in the uterus in order to prevent blood clots, excessive bleeding, and infection. Once removal of fibroids is completed, the lapaproscopic surgical tools are removed and the incision is closed with stitches or clamps.
After Procedure - You will be taken to the post-operative area, watched for complications, and given IV fluids and medications. Once your vital signs are normal (usually within 2-3 hours) you will be moved to a hospital room, or, if laparoscopic surgery was performed, you may be sent home.
How Long Will It Take? 1-2 hours
Will It Hurt? Anesthesia prevents pain during the procedure. However, you can expect abdominal pain or discomfort for 7-10 days after open surgery, and less time (likely 3-4 days) after laparoscopic surgery.
Possible Complications:
Complications from a myomectomy are rare. They include:
- Excessive bleeding
- Anemia and/or need for blood transfusions due to excess blood loss
- Surgical wound infection
- Recurrence of fibroid tumors
- Perforation of the uterus or bowel during surgery
Wall of the uterus may be weakened if removal of a large fibroid leaves a wound extending the complete thickness of the uterine wall
- Adverse reactions to anesthesia
- Need for special precautions in pregnancy, for example, may need to deliver by cesarean section
- Pelvic adhesions that can cause pain and/or bowel obstruction
- Evidence of cancer found during surgery, making removal of the uterus necessary
- Severe scarring, resulting in infertility
Average Hospital Stay: 2-3 days with open surgery, overnight with laparoscopic surgery
Postoperative Care:
- Wear sanitary pads or napkins to absorb blood (unless told otherwise by your surgeon)
- Move and elevate legs while resting in bed to decrease the risk of deep-vein blood clots
- Do not take prescription pain medication for more than 7 days; after 7 days, take non-prescription pain relievers such as ibuprofen
- Bathe or shower as normal, and wash the incision area gently with mild soap until it heals fully
- Do not resume driving for 2 weeks after open surgery, and 4-7 days after laparoscopic surgery
- Avoid strenuous exercise for 6 weeks after open surgery and 2 weeks after laparoscopic surgery
- Do not resume sexual activity until your doctor says it is safe
- To help speed healing and recovery, resume normal activities (including work) as soon after surgery as you feel able
OUTCOME
Full recovery from surgery will take about 4-6 weeks after open surgery, and 2-4 weeks after laparoscopic surgery. The first menstruation after surgery may be heavier than normal.
Eighty percent of the time, the symptoms caused by fibroid tumors are successfully controlled with this procedure. This may include a return to a normal menstrual cycle and the ability to become pregnant, unless the uterus had to be removed.
CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Excessive vaginal bleeding (soaking more than one pad per hour) after surgery
- Excessive vaginal discharge that continues beyond 1 month after surgery
- Vaginal discharge has a foul odor
- Severe abdominal pain
- Headaches, muscle aches, dizziness, or general ill feeling
- Nausea, constipation, or abdominal swelling
- Fibroid tumor symptoms return after surgery
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Pain, burning, urgency, or frequency of urination or persistent bleeding in the urine
- New, unexplained symptoms
SOURCES:
Society of Cardiovascular and Interventional Radiology
Duke University Medical Center (Reproductive Endocrinology and Infertility)
