Myomectomy—Laparoscopic Surgery Overview

This surgery involves removing fibroids from the wall of the uterus (womb). Fibroids are noncancerous tumors in the muscle of the uterus.

Prior to Procedure

Your doctor may do the following:

• Physical exam
• Blood tests
• Review your medicines
• Dilation and curettage (D&C) —a procedure to remove tissue from the lining of the uterus (endometrium)
• Ultrasound—shows images of pelvic organs
• Intravenous pyelogram —x-rays taken of the kidneys, ureters, and bladder after a contrast medium is injected into a peripheral vein (done if the fibroids are affecting the ureters)

You should discuss with your doctor:

• Whether you should have hormone treatment for 2-4 months before the procedure—This treatment shrinks fibroids. It makes them easier to remove and reduces the risk of excess blood loss during the procedure.
• If cancer is found in the uterus—One option is to remove the uterus during the myomectomy.
• Whether you should donate your own blood for the procedure

Leading up to your procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
• Arrange for a ride home from the hospital. Also, arrange for help at home.
• Do not eat or drink for at least eight hours before the procedure.

Anesthesia

General anesthesia is used most often. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

The doctor will make a small cut in the navel. He will insert a laparoscope into the abdomen through the cut. A laparoscope is a tube with a tiny camera on the end. The doctor will use this to examine the abdomen. Two or three additional small cuts will be made in the abdomen. Other tools will be inserted through these cuts. The doctor will find each fibroid and remove it. In some cases, you may be given the drug Pitressin to reduce blood loss. After the fibroids are removed, the doctor will use stitches to close the incision area.

Laparoscopic View of Uterus © 2009 Nucleus Medical Media, Inc.

Be aware that in some cases, the doctor may need to switch to an open surgery . During an open surgery, she will make a larger cut in the abdomen to do the surgery.

Immediately After Procedure

After the procedure, you will be:

• Taken to the postoperative area
• Watched for complications
• Given IV fluids and medicines

How Long Will It Take?

1-2 hours

Will It Hurt?

Your doctor will give you pain medicine to help control the pain.

Average Hospital Stay

You will either stay overnight or leave the hospital the same day as your surgery.

Post-procedure Care

Full recover will take about 2-4 weeks. When you return home, do the following to help ensure a smooth recovery:

• Be sure to follow your doctor's instructions .
• Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
• Try to walk often. This will decrease the risk of blood clots.
• Take medicines as prescribed by your doctor. If you had to stop medicines before the procedure, ask your doctor when you can start again.
• Bathe or shower as normal. Gently wash the incision area with mild soap.
• Ask your doctor when you will be able to:

• Return to work and drive
• Resume sexual activity
• Resume strenuous activity (You may need to wait 2-6 weeks.)

RESOURCES:

National Uterine Fibroids Foundation
http://www.nuff.org/

Women's Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Myomectomy. Duke University Medical Center Reproductive Endocrinology and Infertility website. Available at: http://www.dukehealth.org/Services/Fertility/Programs/Surgery/Myomectomy?search_highlight=myomectomy . Accessed June 1, 2008.

Uterine fibroid treatment options. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patPub/uterineTreatments.shtml#my . Accessed June 1, 2008.