Abdominal Myomectomy

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Uterine Fibroids Blog — An Expert Speaks Out

Real Women, Real Stories, Real Answers! (will open in new window)

Uterine Fibroids Blog — An Expert Speaks Out

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.

Uterine myomectomy - before surgery 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.
Uterine myomectomy - beginning of incision with laser 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.
Uterine myomectomy - fibroid beeing freed from uterus 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.
Uterine myomectomy - fibroid being freed from uterus 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.
Uterine myomectomy - reconstruction of uterus 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.
Uterine myomectomy - reconstruction of uterus complete 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 medical information presented in this website represents the opinion of Dr. Indman, and is based on his knowledge and experience. It is not applicable to all patients or physicians. Anyone visiting this or other related medical sites should discuss symptoms, findings, and alternatives with their personal gynecologist.