Myomectomy

A myomectomy is a surgical procedure where individual large fibroids are removed through an abdominal incision. Dependent on their location and numbers many fibroids can usually be removed laparoscopically (laparoscopic myomectomy), which dramatically reduces recovery time and pain. With  laparoscopic myomectomy there is little on no hospital stay and one can resume normal activities in as little as three days.  

Fibroids which are located inside the uterine cavity, can by removed through the cervix and vagina using the hysteroscope (hysteroscopic myomectomy). This is an outpatient procedure and requires no hospital stay.

Fibroids can sometimes be temporarily treated with Lupron, which is a GnRH agonist medication.  Lupron has the following actions:

• Decreasing bleeding which is often encountered during the myomectomy
• Decreasing the size of the uterus for easier manipulation
• Creating a menopause like state that often shrinks the fibroids by 50%. The effect is temporary and the fibroids will re grow once medication has been discontinued.

INSIGHTEC

Insightec is an FDA approved noninvasive treatment to shrink uterine fibroids. The patient
receives intravenous sedation while they are lying down in an MRI chamber, which is used to localize and direct ultrasound heat energy  to treat the fibroids.

After a session of three to four hours of treatment, the patient is discharged home and can return to work the next day. This method of treatment has minimal or no side effects, and offers many advantages to patients who can now receive relief of symptoms without the risks of surgery.

In severe cases, where the couple does not desire children, hysterectomy may be the treatment of first choice.

Laparoscopy

The laparoscopy is an outpatient surgical procedure used to treat many conditions that cause   infertility including endometriosis, tubal blockage, cysts, fibroids, and others.  Two small incisions are made; one at the belly button and the other at the pubic hair line. The laparoscope, which is a small “telescope like” device, is inserted through one of the openings and operative tools are inserted through the other. There is usually little pain associated with the laparoscopy, depending upon the procedure(s) preformed.

Advanced laparoscopy should be performed by a reproductive endocrinologist/infertility specialist. These specialists have extensive advanced training in laparoscopic surgery and can often treat conditions during the laparoscopic procedure. Many times this eliminates the need for a second “treatment” laparoscopy.

With advanced laparoscopy oftentimes we can avoid the large abdominal incision which require approximately six weeks of recovery compared to the 1-2 weeks (depending on the procedure) with laparoscopic surgery.

Most procedures last about 1-2 hours and the patient can go home the same day. Advanced laparoscopy can result in fewer adhesions (scar tissue) and the benefit of removing most of the disease such as endometriosis.

The recovery times for laparoscopy are much shorter than that for more invasive procedures, such as the laparotomy or open abdominal surgery.