A myomectomy is a surgical procedure that deals with the removal of myomas. There are several approaches and techniques for dealing with leiomyomas also known as fibroids.
The most common method for surgically treating leiomyomas is the laparotomy or minilaparotomy with excision on the tumor(s). The incision is similar to that made to perform a cesarean section, though usually much smaller.
Incisions are made on the uterus where the fibroids are located. The normal muscle is separated from the fibroid using gentle traction and an electrosurgical device.
Care must be taken to minimize bleeding because the normal uterine muscle is highly vascularized and will bleed easily when disrupted.
Surgeons attempt to remove as many of the fibroids through the anterior aspect of the uterus (side closest to the bladder). This is done to reduce the risk of the fallopian tubes and intestines scaring to the incision and interfering with fertility.
This risk is increased with incisions made to the posterior aspect of the uterus, but can be minimized with careful surgical technique. The incisions are also closed in such a manner as to reduce the risk of adhesion (scar tissue) formation.
The Division of Reproductive Endocrinology and Infertility at Duke University has extensive experience with myomectomy procedures as well as expertise in the field of adhesion formation.
Following surgery, the uterine tissue undergoes remodeling and healing. After this process the uterus can take on a normal appearance and function. Depending on the amount of normal muscle that is disrupted by the surgery or displaced by the fibroid, the physician may recommend that labor be avoided in favor of a cesarean section. This is because as the muscle heals scar tissue may form. This scar is prone to rupture during labor.
Not all myomectomies require subsequent cesarean section for delivery so be certain you understand your situation after the surgery.
The majority of myomectomies can be performed in our outpatient surgical center under the extended observation program. This allows patients to maintain nursing care overnight without actually being admitted to the hospital. The recovery period at home is often quite brief.
If you would like to meet with one of our physician to discuss your options please feel free to call us at 919-572-HOPE (4673). If you have had previous testing such as ultrasounds, laparoscopy, or previous surgeries, these reports may be helpful. Please request a copy of these documents.
