Myomectomy-Laparotomy (Remove Uterine Fibroid Tissue)
Myomectomy (Laparotomy), your surgeon makes an open abdominal incision to access your uterus and remove fibroids.
Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. Myomectomy is the preferred fibroid treatment for women who want to become pregnant. After myomectomy, your chances of pregnancy may be improved but are not guaranteed.
Laparotomy is a procedure in which a surgeon makes an incision in the lower abdomen in order to inspect the abdominal cavity. During laparotomy, the surgeon can correct structural problems or remove tumors, sites of endometriosis (implants), or scar tissue (adhesions).
Laparotomy is also used to diagnose and treat female pelvic conditions such as endometriosis, uterine fibroids, ovarian cysts, and ectopic pregnancy. Laparotomy is less commonly used to explore the source of abdominal problems.
Before the Procedure
Your physician will also conduct a full physical exam—including blood and imaging tests.
Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the days before the surgery:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
- Ask your health care provider which drugs you should still take on the day of your surgery.
On the day of your surgery:
- You very often will be asked not to drink or eat anything for 6 – 12 hours before the surgery.
Take the drugs your health care provider told you to take with a small sip of water. Your health care provider or nurse will tell you when to arrive at the hospital
Myomectomy-Laparotomy (Remove Uterine Fibroid Tissue)
Myomectomy-Laparotomy is a minimally invasive procedure, your surgeon accesses and removes fibroids through several small abdominal incisions.
During laparoscopic myomectomy, your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope — a narrow tube fitted with a camera — into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall. During robotic myomectomy, instruments are inserted through similar small incisions, and the surgeon controls movement of instruments from a separate console.
The fibroid is cut into smaller pieces and removed through these small incisions in the abdominal wall or, rarely, through an incision in your vagina (colpotomy).
Laparoscopic and robotic surgery use smaller incisions than a laparotomy does. This means you may have less pain, lose less blood and return to normal activities more quickly than with a laparotomy.
Recovery
Following Myomectomy-Laparotomy, most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be a good idea. Because the incisions are small, recuperation is usually associated with minimal discomfort. Since the abdominal cavity is not opened to air, bacteria are less likely to reach the area of surgery, and the risk of infection is very low. The intestines are not exposed to the drying effect of air, or the irritating effects of the sterile gauze sponges used to hold the bowel out of the way during abdominal surgery. As a result, the intestines usually begin to work normally again immediately after laparoscopic surgery. This avoids the one- or two-day delay before a person is able to eat following regular abdominal surgery. After laparoscopic myomectomy, women usually can walk the day of surgery, drive in about 1 week and return to normal activity, work, and exercise within two weeks.
Risks
Although there can be problems that result from surgery, we work very hard to make sure it is as safe as possible. However, problems can occur, even when things go as planned. You should be aware of these possible problems.
Possible risks during surgery include:
- Infection of the uterus, fallopian tubes, or ovaries (pelvic infection) may occur.
- Removal of fibroids in the uterine muscle (intramural fibroids ) may cause scar tissue
- In rare cases, scarring from the uterine incision may cause infertility.
- In rare cases, injuries to the bladder or bowel, such as a bowel obstruction, may occur.
- In rare cases, uterine scars may break open (rupture) in late pregnancy or during delivery.
- In rare cases, a hysterectomy may be required during a myomectomy. This may happen if removing the fibroid causes heavy bleeding that cannot be stopped without doing a hysterectomy.
- Blood clot in the legs or lungs