In cases of fibroids in which a woman wishes to preserve her fertility, a myomectomy may be the best procedure. However, it is not that simple. Cutting into the uterine tissue in order to remove these masses can be a difficult process, which requires meticulous planning and attention to detail. Here at the Seckin Endometriosis Center (SEC), we limit your concerns by utilizing several different techniques for removing fibroids, including hysteroscopic and laparoscopic removal. With over three decades of experience in fibroid surgery, we are confident in our standard techniques that have been established to use strictly for laparoscopic surgeons, ensuring almost scarless incisions. We have also developed our bloodless myomectomy procedure, with a unique novel tourniquet technique in addition to standard putrescent, for our more complex fibroid surgeries. This ensures minimal blood loss and stresses the vast importance of uterine suturing and reconstruction following the fibroid removal in order to preserve the uterus and maintain fertility. While most women are usually offered abdominal myomectomies, which require large incisions, our myomectomy techniques guarantee minimal invasion, a fast healing time and nearly-scarless results.
A myomectomy, derived from the words myoma (fibroid) and ectomy (to remove), is simply defined as the removal of fibroids from the uterus. When a woman wishes to preserve the ability to bear children and suffers from fibroids, a myomectomy is the preferred procedure as it preserves the uterus as opposed to a hysterectomy.
Benign fibrous tumors that grow in the muscle layers of the uterus are termed fibroids. Fibroids can also be termed myomas or leiomyoma. It is important to note that it is a common misconception to believe that fibroids are cancerous. They are not. Fibroids, while considered tumors (swollen masses) are benign (non-cancerous) growths that develop in the uterine muscle. They can grow within the wall of the uterus (myometrium), outside the wall of the uterus, on a stalk and more. The following classifications of fibroids are made, based off of where they are located:
To read more about fibroids and how they are classified, Click Here.
According to US News Health, about 34,000 myomectomies are performed on women in the U.S. each year . However. even more commonly, 200,000 hysterectomies are performed each year in order to treat fibroids. This makes up about ⅓ of hysterectomy cases within the country.
At first glance, it may be alarming to see that hysterectomies are over 5 times more common than myomectomies in the treatment of fibroids. The reasoning for this is that a myomectomy is a more invasive procedure than a hysterectomy. While a myomectomy does preserve the uterus and its function, fibroids most often grow within the muscle of the uterus. Thus excising out the fibroid through a myomectomy procedure requires uterine repair and healing. It also can require larger incisions to be made, as the fibroid must be removed through the abdomen. A hysterectomy, on the other hand, removes the uterus in its entirety and can be performed more easily through smaller incisions. However, a hysterectomy, while less invasive, should only be performed in cases of fibroid treatment if the fibroids keep reoccurring and the patient is not looking to preserve her fertility, as once the uterus is taken out she can no longer bear children.
This begs the question: If a myomectomy takes longer to heal and is more invasive than a hysterectomy, then when is it recommended?
A pedunculated fibroid on a stalk is much more easy to remove compared to a submucosal fibroid buried within the muscular wall of the uterus.
Remember, in cases where fertility is no longer an option and fibroids are recurring, a hysterectomy should be considered. Nevertheless, you should always discuss your plans and desired form of surgery with your doctor in order to ensure that you are both comfortable and fully understand the treatment to come.
A singular fibroid removed following a myomectomy procedure.
There are several different forms of myomectomy procedure, which vary in use based on the size and location of the fibroid itself. All of the following myomectomy procedures are performed in the operating room, under anesthesia.
To lower one’s risk for fibroid regeneration and other more harmful diseases following a myomectomy or hysterectomy procedure, patients are often prescribed hormonal replacement therapy. These hormone therapies can vary depending on the type of procedure that was conducted.
It is crucial to note that not all patients have the same medical history and thus, hormone replacement therapy is not for everyone. Women should be highly informed by their surgeons of the risks and benefits of such precautionary measures so that they can agree upon a treatment that is right for their particular case.
Because a myomectomy is a procedure to remove fibroids, the symptoms that can warrant the procedure are linked to fibroids. Therefore the following symptoms should all be considered when a patient is concerned about having fibroids:
Before a patient can receive a myomectomy, several preoperative evaluations must be made in order to confirm a presumptive diagnosis of fibroids, as well as to ensure the patient is capable of going through a myomectomy procedure.
A myomectomy is primarily performed in order to preserve the uterus so that it can bear a child during pregnancy. Another reason why a myomectomy can increase a woman’s fertility is that the fibroids removed can also be preventing the patient from getting pregnant in the first place, leading to issues in conceiving the child itself. This can occur through fibroids blocking the path of a sperm cell such as through the cervix, uterus or fallopian tubes. Finally, the type of fibroid that develops can actually play a role in the severity of the patient’s infertility. For example, while intramural and cervical fibroids can make it difficult to conceive a child, submucosal fibroids have been linked to both complications conceiving children and miscarriages. A myomectomy is thus a highly useful technique used in treating these cases of infertility, as it not only removes the fibroid(s) but also looks to repair and restore uterine function.
Understanding the procedure itself, including the type of myomectomy that will be performed, will help you familiarize yourself with what to expect the day of surgery. Make sure you understand what you consent to before signing. For the patient, this truly is the most important part of your process during your preoperative course. Remember, asking the right questions will bring the right answers. Based on your symptoms and preoperative diagnostic tests such as a hysteroscopy, sonohysterography and more, your surgeon should be able to give you a presumptive estimate as to where your fibroid is located, and in turn, the technique that will be used to remove it. While a hysteroscopy and hysteroscopic myomectomy can be part of any myomectomy procedure, the location of your fibroids can lead to different techniques being performed on the day of your surgery. Nevertheless, you must also be aware that this is a presumptive diagnosis and thus every fibroid surgery, whether it is hysteroscopically or laparoscopically performed, may be complicated. This can mean a more than expected number of fibroids, larger fibroids, more blood loss, etc. For these reasons it is important to be well informed and ready for your surgery, and here are a few ways in which you can do so:
|Hysteroscopic myomectomy||Laparoscopically-assisted myomectomy (vaginal route)||Laparoscopically-assisted myomectomy (abdominal route)||Robotic myomectomy||Open myomectomy|
|Number of incisions||0 incisions||2-3 incisions||4 incisions||5 incisions (2.5cm)||1 large incision|
|Size of incisions||No incisions||1.5-2.5cm (abdominal) incisions||3 small (1cm) and 1 large (>5cm) incisions||3 small (7mm) and 2 large (2.5cm) incisions||5-20cm incisions|
|Length of procedure||<1 hr||1-3 hrs||1-3hrs||2-4 hours||Less than 3 hours (depends on number of fibroids)|
|Hospital stay||Same day release||0-1 days||1-3 days||1-2 days||3 days|
|Recovery time||None||Less than a week||2-4 weeks||2-4 weeks||6-8 weeks|
As noted above, the type of myomectomy surgery you undergo will affect your recovery time and any symptoms felt after. For example, following a hysteroscopic myomectomy there will be some degree of spotting or a short period, whereas, after a laparoscopic myomectomy, there will be some discomfort and pain immediately following surgery, which should resolve over the next few hours. This pain can be controlled using non-steroid anti-inflammatory drugs (NSAID) and more powerful pain relievers such as Percocet or hydromorphone. However, we do not like to give narcotic oral medication more than one or two days following surgery due to the tendency of drug dependency when this type of medication is prescribed. It can also slow down the GI tract, causing constipation and bladder dysfunction.
Below are other things to be mindful of following your myomectomy surgery:
Myomectomies have a low rate of complication, especially in the hands of a skilled surgeon. However, like any procedure, there are risks to be mindful of, which include:
We have spent over two decades meticulously perfecting our myomectomy technique, which is catered specifically to your case, depending on the type of fibroid that needs to be removed. Below are the ways in which we removed fibroids, depending on their specific classification:
Reconstructing the uterus is required in any procedure that cuts into the uterus, such as intramural fibroids. By seamlessly suturing the uterine wall, we are to conserve uterine function.
Morcellation is a common technique that surgeons use to remove fibroids. It uses a round knife in order to cut the fibroid piece by piece, which is then all removed separately. This method is known to cause the spillage of blood and other contents, such as leftover fibroid pieces. In fact, recent research studies have shown that when fragments of the myoma are left behind following morcellation, they can seed and grow, termed parasitic myomas [Paul, P. G., 2006] This is why we have taken great care to master and improve our bloodless myomectomy technique. On top of this, we also use copious irrigation and an underwater examination following any myomectomy procedure, in order to check if there is any oozing from the bed of the tissue from where the fibroid was removed. Using all these measures, we are able to ensure our patients that this issue of blood spillage and leftover fibrous content is not a cause for their concern.
While we are trained in the use of robotic surgery, we generally stray away from robotic procedures, especially when it comes to a myomectomy. As noted before, one of our major goals in any myomectomy procedure is to limit the amount of blood spillage. With over two decades of experience in removing fibroids, we have worked tirelessly to make our bloodless myomectomy technique do exactly this. It is a procedure that requires meticulous execution in order to be performed properly. For these reasons, we prefer to have the procedure in our own hands as opposed to operating through robotics. Though robotics can have some benefits, it does not replace the skills developed by a surgeon who has decades of practice and experience.
A myomectomy is a highly personal surgery, especially in cases wherein the fibroids are located deep within the uterine muscle wall. For this reason, it is crucial to find a surgeon who will treat you with the personalized care and patience that you deserve. Your surgeon should feel comfortable answering any questions you may have, on top of going through all options that are choices in your particular case. Here at the Seckin Endometriosis Center, we pride ourselves on keeping our patients informed so that they can decide if such procedures as a myomectomy, us the right choice for their particular case.
Tracee M was diagnosed with uterine fibroids in 2010. Five years later, she was referred to the Seckin Endometriosis Center where she underwent a bloodless myomectomy procedure. Read about Tracee’s story here and how her symptoms have since been resolved.
You can read more stories of patients who received myomectomies, at varying stages, in our testimonial section.
After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin, I was experiencing almost daily terrible pain to the point where I had difficulty walking, inability to eat, inexplicable weight…
Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well. They were all caring, kind, patient, and took the time to listen to me and explain anything I needed to…
Dr. Seckin and his staff spared me from years and years of heavy periods and unbearable endometriosis pain. After having surgery with him (my first) I can now function like a regular human. No more eating NSAIDs like candy and calling out sick from work. Thank you, Dr. Seckin!
I underwent surgery with Dr. Seckin in 2017 and have felt like a new woman ever since. If you have, or suspect you have endometriosis, Dr. Seckin and his compassionate team of surgeons and staff are a must-see.
I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We traveled over 5 hours each way to see him, but it was definitely worth it. He removed disease from several…
Seckin and Dr. Goldstein changed my life!
Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma on my left ovary, for the second time in my life. This is when I finally found Dr. Seckin and…