Uterine Fibroids and Hysterectomy - Medications

Surgical Alternatives to Hysterectomy

Myomectomy

A myomectomy surgically removes only the fibroids and leaves the uterus intact, often preserving fertility. Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids. Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary.

To perform a myomectomy, the surgeon may use a standard "open" surgical approach (laparotomy) or less invasive ones (hysteroscopy or laparoscopy).

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• Laparotomy. Laparotomy uses a normal abdominal incision and conventional "open" surgery. It is used for subserosal or intramural fibroids that are very large (usually more than 4 inches), that are numerous, or when cancer is suspected. While complete recovery takes less than a week with laparoscopy and hysteroscopy, recovery from a standard abdominal myomectomy takes as many as 6 - 8 weeks. Open laparotomy poses a higher risk for scarring and blood loss than with the less invasive procedures, a concern for women who want to retain fertility.
• Hysteroscopy. A hysteroscopic myomectomy may be used for submucosal fibroids found in the uterine cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. The doctor then uses an electrosurgical wire loop to surgically remove (resect) the fibroid.
• Laparoscopy. Women whose uterus is no larger than it would be at a 6-week pregnancy and who have a small number of subserosal fibroids may be eligible for treatment with laparoscopy. As with hysteroscopy, thin scopes are used that contain surgical and viewing instruments. Laparoscopy requires only tiny incisions, and has a much faster recovery time than laparotomy.

Complications. The risks for myomectomy are generally the same of those for other surgical procedures, including bleeding and infection.