Myomectomy is the surgical removal of uterine fibroids without the removal of the uterus. There are several techniques that may be used, and the choice of the technique depends on the location and size of the fibroids as well as the characteristics of the woman. It is sometimes impossible to remove all the fibroids, and new fibroids may grow after a myomectomy. Though myomectomy is the only accepted procedure for fibroids in a woman who wants to maintain fertility, a myomectomy may lead to scarring that can negatively affect future fertility. Following a myomectomy, cesarean delivery is frequently recommended to prevent the myomectomy scar from breaking open during labor.
Types of myomectomies include:
• Laparoscopic myomectomy
• Abdominal myomectomy
• Hysteroscopic myomectomy
Abdominal hysterectomy is the removal of the uterus performed through a horizontal (“bikini”) or vertical incision in the abdominal wall, using traditional instruments and surgical techniques. Most patients have general anesthesia (go to sleep) and are hospitalized for 1-2 nights. Full recovery generally takes 4-6 weeks during which time heavy lifting must be avoided. Driving should be avoided for 1-2 weeks, and sexual intercourse should be avoided for 6 weeks.
When the cervix and the uterus are surgically removed by operating through the vagina, this is called a vaginal hysterectomy. This procedure has been a standard in gynecology for over 50 years. As the rate of hysterectomy has declined, and as other methods have been developed, more recently trained gynecologists have had less experience performing this procedure. When it is surgically possible to perform vaginal hysterectomy, then the laparoscopic approach has few advantages when the surgeon is equally skilled at both. There are some situations which increase the risk of vaginal hysterectomy, however: multiple prior Cesarean sections, other major abdominal surgery, past pelvic infections, endometriosis, obesity, small pelvic bony canal, etc. Hospital stay is usually 1 night and recovery time is approximately 2-3 weeks. In most circumstances, if a woman has not delivered a full-term baby vaginally, the hysterectomy is more easily accomplished by the laparoscopic route. There is now good evidence that less blood is lost in a laparoscopic hysterectomy than in a vaginal procedure.
Laparoscopic total hysterectomy (removal of uterus and cervix) Laparoscopic hysterectomy involves removing the entire uterus with minimally-invasive techniques, using a narrow telescope-like instrument (laparoscope) to see the inside of the abdomen. Under complete general anesthesia, the abdomen is first inflated with carbon dioxide gas to create space for operating. Four or five incisions (1/4 to ½ inch each) are made in the navel and lower abdomen to allow insertion of both the laparoscope and long, narrow instruments through tubes called “ports.” (When using the robot, the incisions are higher up, at the level of the belly button and higher up towards the head.) A normal sized uterus, once it is detached from its supports, can be removed through the vagina. A large uterus can be reduced to smaller pieces using a laparoscopic morcellator. With our long experience and high volume, we are comfortable removing a uterus as large as a 30 week pregnancy. Once the uterus is removed, the inside edges of the vagina are brought together using suture, which is readily done laparoscopically.
-Laparotomy for ectopic pregnancy
-Surgeries for uterine Prolapse
-Dialatation and Curettage
-Suction and Evacuation
-And many more