Myomectomy is a surgical procedure designed to remove noncancerous uterine fibroids, which are abnormal growths within the muscular wall of the uterus. This intervention is often chosen by women seeking relief from symptoms associated with fibroids, such as heavy menstrual bleeding, pelvic pain, or pressure. Myomectomy is a fertility-preserving option, allowing women to retain their uterus and potentially enhance their chances of successful pregnancy in the future. The procedure can be performed through various surgical techniques, and the choice of approach depends on factors such as the size, number, and location of the fibroids, as well as the patient’s medical history and reproductive goals. 

History of Myomectomy  

The first recorded myomectomy dates back to the late 19th century when pioneer gynecologist Dr. Howard Atwood Kelly performed the procedure in 1883. However, it wasn’t until the 20th century that myomectomy gained recognition as a viable treatment for uterine fibroids. In the early 1900s, the surgical approach transitioned from primarily abdominal procedures to more refined techniques. Dr. Thomas Cullen, in 1909, introduced the concept of myomectomy via laparotomy, marking a significant advancement. Over the following decades, innovations in anesthesia, surgical instrumentation, and minimally invasive techniques further transformed myomectomy. The advent of laparoscopy in the mid-20th century and, later, hysteroscopy in the 1980s, revolutionized the field, offering less invasive alternatives for patients. Today, myomectomy continues to evolve with ongoing research into advanced technologies and robotics, aiming to optimize outcomes and minimize invasiveness. 

Types of Myomectomy  

The surgical approach can vary based on factors such as the size, location, and number of fibroids, as well as the patient’s overall health and reproductive goals. There are three primary methods for performing myomectomy: 

Abdominal Myomectomy (Laparotomy): 

• This traditional approach involves making an incision in the abdominal wall to access and remove the fibroids from the uterus. Abdominal myomectomy is typically recommended for larger fibroids or when multiple fibroids are present. 

Laparoscopic Myomectomy: 

• In laparoscopic myomectomy, small incisions are made in the abdominal wall, and a laparoscope (a thin, lighted tube with a camera) and specialized instruments are used to remove the fibroids. This minimally invasive approach often results in a faster recovery compared to laparotomy. 

Hysteroscopic Myomectomy: 

• Hysteroscopic myomectomy is suitable for fibroids that are primarily within the uterine cavity. A hysteroscope, a thin tube with a light and camera, is inserted through the cervix, allowing the surgeon to visualize and remove the fibroids without any external incisions. 

Myomectomy is generally considered safe, but like any surgery, it carries potential complications. Understanding these risks is crucial for individuals considering or undergoing this procedure. Here are details on five possible complications: 

Excessive Bleeding: 

• Excessive bleeding during myomectomy is a potential complication, especially in cases involving large or numerous fibroids. Surgeons take measures to minimize blood loss, but complications can arise, necessitating blood transfusions or additional interventions to address hemorrhage. 

Infection: 

• Infections at the incision sites or within the pelvic cavity are possible complications of myomectomy. Although the risk is generally low, proper sterile techniques and postoperative care are crucial to reduce the likelihood of infection. Symptoms may include fever, pain, or abnormal discharge, and prompt medical attention is necessary if infection is suspected. 

Adhesions: 

• The formation of scar tissue, or adhesions, in the pelvic region is a potential complication. Adhesions can cause pain, discomfort, or complications related to fertility. Surgeons employ techniques to minimize adhesion formation, but in some cases, adhesions may develop and require additional treatment. 

Uterine Perforation: 

• Uterine perforation, though rare, is a serious complication involving unintentional puncturing or tearing of the uterus during the surgery. This may require immediate attention and possible further surgical intervention to repair the perforation. 

Impact on Fertility: 

• While myomectomy is generally considered a fertility-preserving procedure, there is a risk that the surgery itself or the development of adhesions could impact fertility. Careful consideration and discussion with the healthcare provider are essential, especially for women with reproductive goals, to weigh the potential benefits against this risk. 

Experience compassionate care and expertise with Dr. Ayesha, a leading specialist in myomectomy. If you’re seeking relief from uterine fibroids and considering a personalized treatment plan, schedule your consultation today. Dr. Ayesha is dedicated to providing exceptional care and guiding you through a seamless journey to improved reproductive health. Take the first step – book your appointment now and regain control over your well-being.