If the fibroid/fibroids are small and located mostly within the uterine cavity, the procedure may be performed with a hysteroscope. This scope is place through the cervix and into the uterus and allows the surgeon to directly visualize the inside of the uterus. If a fibroid is present, a small loop is used to cut the fibroid away from the uterine wall. No incisions are necessary on your abdomen or on your pelvic organs or vagina. You may experience some light vaginal bleeding or spotting after this procedure. This procedure does not require an overnight stay in the hospital.
If you have one or two fibroids you may be a candidate for a Laparoscopic Myomectomy depending on the size and location of your fibroids. Laparoscopic surgery is a type of minimally invasive surgery in which small incisions (cuts) between 0.5 to 1 cm are made on the abdominal wall through which an instrument called a laparoscope can be placed. The laparoscope allows the surgeon to visualize the abdomen and pelvis. The abdominal cavity is able to be visualized by distending it with an absorbable gas, typically, carbon dioxide. Small instruments can be placed through the small incisions allowing the surgeon to remove the fibroids and repair the uterus with suture without the need for a large surgical incision. Patients must receive general anesthesia during the procedure and typically stay overnight in the hospital for monitoring.
The advantages of laparoscopy over traditional abdominal surgery include the following:
- Less blood loss
- Less post-surgical pain/less medication
- Quicker recovery and return to normal activities
- Less scarring
- Less likelihood of complications
- Preservation of fertility
Robotic Myomectomy is a type of minimally invasive surgery that allows the surgeon to use a combination of high-definition 3D magnification, a robot, and small instruments which allow the surgeon to remove uterine fibroids and repair the uterine wall. The camera used in robotic surgery gives the surgeon enhanced detail and true depth of field. The robotic hands are superior to laparoscopic instruments given they allow better range of motion for suturing (sewing) which is essential during a myomectomy to repair the uterine wall. The robotic instruments are directly controlled by the surgeon and offer a broad range of movement which is helpful when a surgeon needs to repair the uterine wall where a large fibroid or deep fibroid once existed. Robotic surgery is like laparoscopic surgery however the incisions we make are slightly larger 0.1-2 cm. Robotic myomectomy may be recommended to you if you have one or more large fibroids that will requiring extensive suturing to repair the uterus. However this type of minimally invasive surgery is typically not recommended if you have many fibroids, or many small fibroids.
An Abdominal Myomectomy is the removal of fibroids from an abdominal incision (cut). The size and location of the incision will depend on the overall size of your uterus and number of fibroids you have. The abdominal approach is usually reserved for patients with a large number of fibroids, or very large fibroids. The advantages of the Abdominal Myomectomy in this setting is that it allows the surgeon the ability to actually feel the uterus and allows the surgeon to find fibroids deep inside the uterus that may not be visible just by looking. The disadvantages are a longer hospital stay, longer recovery period. Because the incision is larger than those made in laparoscopic surgery, one will likely experience more pain in the post-operative period as well. We will use pain medications to help you manage. Patients typically require a 48 to 72 hour hospital stay.
To learn more about the variety of myomectomy surgical procedures available at Advanced & Minimally Invasive Gynecology, including robotic-assisted and minimally-invasive options, contact our practice.