Fibroid Removal

What is Fibroid Removal?

Fibroid removal, also called myomectomy, is a surgical procedure to remove uterine fibroids— non-cancerous growths in the uterus that can develop during a woman's childbearing years. There are several methods for removing fibroids, including hysteroscopic myomectomy, laparoscopic myomectomy, and abdominal myomectomy, depending on the fibroids' size, number, and location.

Uterine fibroids can cause several health problems, such as heavy menstrual bleeding, pelvic pain, and reproductive issues. So, the procedure is often recommended for women with symptoms caused by uterine fibroids who want to keep their uterus intact, particularly for future pregnancies.

Who is Suitable for Fibroid Removal?

Some factors that may make a person suitable for fibroid removal include:

Severe symptoms: Heavy menstrual bleeding, pelvic pain, and discomfort that interferes with daily activities.
Infertility or recurrent miscarriages: If fibroids are believed to be a cause, removal might increase fertility.
Planning to become pregnant: Removal of fibroids can reduce the risk of complications during pregnancy.
The rapid growth of fibroids can sometimes indicate a more serious problem so removal might be recommended.
Position of the fibroids: If they are located where they could cause complications, they may need to be removed.

Benefits of Fibroid Removal

Symptom relief: Fibroid removal can significantly reduce symptoms such as heavy menstrual bleeding, pelvic pain, and frequent urination.
Preservation of the uterus: For women who wish to have children in the future, fibroid removal is often a better option than a hysterectomy (complete removal of the uterus), as it preserves the uterus.
Increased fertility: Some studies suggest that fibroid removal can improve fertility rates in women with infertility, likely due to fibroids.
Improved quality of life: By relieving the painful and uncomfortable symptoms associated with fibroids, fibroid removal can greatly enhance an individual's overall well-being and quality of life.

Types of Fibroid Removal

Hysteroscopic Myomectomy: This is used for fibroids mostly located in the uterine cavity. A surgeon inserts a small, lighted instrument through the vagina and cervix into the uterus to remove the fibroids.
Laparoscopic Myomectomy: This is used for fibroids that are located on the outer surface of the uterus. A surgeon makes small incisions in the abdomen to insert a laparoscope (a thin tube with a camera) and other small instruments to remove the fibroids.
Abdominal Myomectomy: This is used for larger or multiple fibroids. A surgeon makes a larger incision in the abdomen to access and remove the fibroids. It can be a more invasive procedure with a longer recovery time.
Robotic Myomectomy: Similar to a laparoscopic myomectomy but performed with a machine controlled by the surgeon, this allows for more precise movements in hard-to-reach areas.

The type of myomectomy a doctor recommends depends on the fibroids' size, number, and location. Each method has advantages and potential complications so the best approach will depend on the individual's circumstances and overall health. Patients need to discuss these options thoroughly with their healthcare providers.

Alternative Options to Fibroid Removal

Medication: Certain medications can help manage symptoms of fibroids. Gonadotropin-releasing hormone (GnRH) agonists, for instance, can reduce oestrogen production and cause fibroids to shrink. Birth control pills can help control heavy menstrual bleeding. However, these don't eliminate fibroids; their effects are usually temporary.
Uterine Fibroid Embolization (UFE): This is a minimally invasive procedure where a doctor injects small particles into the arteries supplying blood to the uterus, cutting off blood flow to the fibroids and causing them to shrink.
MRI-guided Ultrasound Surgery: This non-invasive treatment uses high-intensity ultrasound waves to destroy the fibroids. The procedure is guided by magnetic resonance imaging (MRI).
Endometrial Ablation: This involves removing or destroying the lining of the uterus to control heavy menstrual bleeding. It's less effective when fibroids are large or numerous.
Hysterectomy: This is the surgical removal of the entire uterus. It's a permanent solution, but it prevents future pregnancy and is typically considered only when other treatments have failed or aren't possible.

Preparation for Fibroid Removal Surgery

Medical History: Ensure your doctor knows your full medical history, including allergies, medical conditions, or previous surgeries.
Medications: Inform your doctor about any medications, vitamins, or supplements you take. Some of these may need to be stopped temporarily before the surgery.
Preoperative Testing: Your doctor might order certain tests, like blood or imaging studies, to evaluate your health before the procedure.
Fasting: You'll likely be asked to avoid eating or drinking for a certain period before the surgery.
Arrange for Help: Since you may be in the hospital for a few days and need time to recover, arranging for someone to drive you home and assist you with daily tasks is helpful.

Fibroid Removal Procedure

The exact procedure will depend on the type of fibroid removal (myomectomy) performed: hysteroscopic, laparoscopic, abdominal, or robotic. Here is a general idea of what happens:

Anaesthesia: You'll receive anaesthesia to prevent pain. The type of anaesthesia may depend on the specific procedure. Still, it could be general anaesthesia, where you're asleep during surgery, or regional anaesthesia, where only part of your body is numbed.
Procedure: The surgeon will then remove the fibroids using one of the following methods:
Hysteroscopic Myomectomy: The surgeon inserts a thin, flexible telescope (hysteroscope) through the vagina and cervix into the uterus. The fibroids can then be seen and removed.
Laparoscopic Myomectomy: The surgeon makes a few small incisions in the abdomen. A laparoscope is inserted through one of the incisions to guide the surgeon, while special surgical tools are inserted through the other incisions to remove the fibroids.
Abdominal Myomectomy: The surgeon makes a larger incision in the lower abdomen to access the uterus and remove the fibroids.
Robotic Myomectomy: The surgeon uses a computer to control surgical instruments attached to robotic arms to remove the fibroids. The surgeon views the area through a 3D camera attached to one of the robotic arms.
Closure: Once the fibroids have been removed, the surgeon will close any incisions made. Depending on the type of myomectomy, this may involve stitches, surgical staples, or surgical glue.

Post Fibroid Removal Expectations

After the surgery, you'll be taken to a recovery room, where healthcare professionals will monitor your vital signs as you wake up from anaesthesia. Depending on the type of myomectomy performed, you may need to stay in the hospital for a few days.

Fibroid Removal Recovery Plan

Your doctor will provide you with a specific recovery plan, but general steps often include the following:

Rest: You may need to rest for a few days to several weeks after surgery, depending on the type of procedure performed.
Pain Management: You'll likely be given pain relievers to manage discomfort after the surgery.
Activity: Gradually increase your physical activity as you recover. Avoid heavy lifting and strenuous exercise until your doctor gives you the go-ahead.
Follow-Up Appointments: Attend all follow-up appointments so your doctor can monitor your healing and address any concerns.
Healthy Lifestyle: Maintain a healthy diet and lifestyle to support your recovery.

Fibroid Removal Prognosis

Myomectomy is generally a very effective surgery; most women experience significant or complete relief of symptoms. However, fibroids can regrow in the future, particularly if you have multiple or large fibroids. If you plan to get pregnant, there's generally a good chance of a successful pregnancy after myomectomy.

Fibroid Removal Risks

As with any surgery, fibroid removal carries risks, including:

Infection: Any surgery carries a risk of infection.
Bleeding: More blood loss can occur during myomectomy than other surgical procedures.
Scar Tissue: Surgery can lead to scar tissue formation, which can cause complications, including infertility.
Damage to Surrounding Organs: There's a risk of damage to other organs during surgery, such as the bowel or bladder.
Fibroid Recurrence: Fibroids can return after surgery, and further treatment may be necessary.
Complications with Pregnancy: Although many women have successful pregnancies after myomectomy, there can be an increased risk of complications, such as uterine rupture in labour.

What if Fibroid Removal is Delayed?

If fibroid removal is delayed, the fibroids may continue to grow. This could result in worsening symptoms, such as heavier menstrual bleeding, more severe pelvic pain, and increased pressure on the bladder or bowel. In some cases, untreated fibroids can lead to fertility problems.

However, not all fibroids cause symptoms, and many don't require treatment. If you have fibroids but no symptoms, your doctor may recommend simply monitoring them instead of proceeding with surgery. Always discuss the best course of action with your healthcare provider.

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