Hysteroscopic Myomectomy

Hysteroscopic Myomectomy

Uterine myomas, or fibroids, are benign tumors of smooth muscle and fibrous tissue in the uterine wall. Although commonly called tumors, they are not cancerous. Myomas may be small or large and one or many in number, develop slowly, and are usually asymptomatic in most instances. Unless symptoms arise, treatment is unnecessary, which is the case for about 25% of patients. Myomas may occur as single nodules or in groups, from 1 mm to greater than 20 cm in diameter. They are the most commonly diagnosed pelvic tumor of the female and a common indication for hysterectomy.

Symptoms of Uterine Myomas

Myomas may cause a variety of symptoms, including:

• Prolonged and heavy menstrual bleeding
• Pelvic pressure or pain
• Abdominal distention or weight gain
• Bladder or bowel pressure
• Back pain or leg pain
• Painful sexual intercourse

Causes of Uterine Myomas

The cause of myoma development is still unknown. They mainly occur in women in their reproductive years and never before the onset of estrogen secretion. Myomas may grow at a very fast rate during pregnancy because of elevated levels of estrogen and tend to decrease after menopause because of decreased hormone levels.

Treatment: Myomectomy for Fibroid Removal

Myomectomy is a surgical technique to remove fibroids without removing the uterus. This is an alternative to hysterectomy, allowing women to maintain their reproductive capacity. Although at times more complicated than a hysterectomy, myomectomy has considerable advantages.

Advantages of Laparoscopic Myomectomy

• Less invasive with small cuts and less scarring
• Less trauma to organs and tissues
• Lower post-operative pain
• Reduced need for narcotics to alleviate pain
• Reduced hospital stay
• Reduced recovery time and sooner return to normal activities

Procedure: How Laparoscopic Myomectomy Is Done

Preoperative Preparation:

• Patients have to fast for six hours.
• Preoperative interventions can be shaving and an enema.

Surgical Procedure:

• General anesthesia is used.
• A laparoscope and operating instruments are inserted.
• The fibroid is identified and a cut made in the uterus.
• The fibroid is gently dissected from the muscle of the uterus.
• The incision in the uterus is closed.
• The fibroid is removed, usually in smaller fragments with a specialized device known as a morcellator.
• Surgical wounds are closed.

Postoperative Recovery

• Hospital stay is typically about two days, with some being discharged the day following surgery.
• Pain relief is individualized to suit each case, with oral or injectable pain medication offered as needed.
• Mild fever is the rule during the first few days postoperatively.
• Rest, hydration, and gentle movements should be used to avoid blood clots.
• Progressive activity is recommended, but fatigue and slight bowel irritation will last temporarily.
• Daily activities can usually return to normal in 2-3 weeks, depending on recovery rates.
• Sexual intercourse should be avoided for a minimum of six weeks after surgery.

By knowing the nature, presentation, and treatment of uterine myomas, one can make well-informed healthcare choices with the advice of their health care providers.

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