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What is an
"abdominal myomectomy?
An
abdominal myomectomy is the removal of fibroids through an incision in
the abdomen. I usually can do this through a horizontal
("bikini") incision, even for large fibroids. There is no
limit to the size or number of fibroids that can be removed.
Abdominal myomectomy is done in a hospital, and women usually can go home
within 48 hours of surgery. Photos
below show an actual abdominal myomectomy.
Is
there much blood loss with myomectomy?..
Usually
there is little loss of blood when a myomectomy is done by a surgeon
with extensive experience in the procedure. There are a number
of ways to reduce blood loss. I use a laser to make the incision
into the uterus, which seals blood vessels and reduces bleeding.
Before the incision, medicines are injected into the uterus to shrink
blood vessels. As a result, I find it unusual to lose an excess
amount of blood during a myomectomy, even with large fibroids. There
are a number of surgical techniques to reduce blood loss, so it is
important to find a surgeon who is experienced in myomectomy.
What
are the advantages and disadvantages of an abdominal myomectomy?
The
ability to actually feel the uterus allows me to find fibroids deep inside
the uterus that may not be visible just by looking. As you can see
from the photos, being able to hold the uterus allows me to accurately
repair the area from which large fibroids have been removed.
The
disadvantage of an abdominal myomectomy is that it requires an incision,
so recovery is somewhat longer than required if an incision is
avoided. Fibroids that are on the inside of the uterus (submucous)
can usually
be removed with a resectoscope, without requiring any
incision. Fibroids on the outside of the uterus (subserous) can sometimes be removed through a laparoscope,
through several small incisions. I feel that this is often the method of choice
for subserous or pedunculated (on a stalk) fibroids. If there are many fibroids or fibroids that are deep I can do a
better job by doing an abdominal myomectomy. Most women feel that in
the long run doing the best possible procedure to restore the health of the
uterus is more important than recovering several weeks sooner.
How
is an abdominal myomectomy done?
Here
are photographs of an actual abdominal myomectomy.
 |
Here is
the abdomen before surgery. The uterus is the size of a 5
month pregnancy. It can be seen to protrude up to the belly
button. |
|
 |
The
uterus, which, is greatly enlarged by the fibroid, is lifted through
the incision. A laser is being used to make an incision into
the uterus so the fibroid can be removed. |
|
 |
The
fibroid is being separated from the wall of the uterus (myometrium).
It is very important to do this in the exact location between the
fibroid and the myometrium in order to prevent excess bleeding. |
|
 |
This shows
the fibroid almost completely free from the uterus. It is
attached only at the base. The blood vessels at the base are
being sealed with an electrosurgical device. |
|
 |
The uterus
is being reconstructed by suturing the walls together with
dissolving suture. This is being done in multiple layers to
ensure a precise repair. |
|
 |
The last layer of
sutures is placed, and the uterus is completely restored. A
barrier to prevent adhesions will be placed before the uterus is
replaced into the abdomen and the abdomen closed. |
|
What
is the recovery time for an abdominal myomectomy?
Recovery
varies tremendously from person to person. Most women can return to
work that does not require heavy lifting in 4 weeks. Many women can
return in 2 weeks, and some women take 6 weeks.
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The
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