There are various ways that can be used to perform a myomectomy surgery. However, it is up to the surgeon to choose a particular approach, selection of which further depends on a number of factors. For example, it depends on the number and location of lesions and also on the preference and the experience of the surgeon.
The following are some of the common approaches used to perform myomectomy in India:
Laparotomy: It is also referred to as abdominal myomectomy. The surgeon makes a full abdominal incision either vertically or horizontally. In a horizontal incision, the surgeon makes a cut of about an inch above the pubic bone which follows the natural skin lines.
In a vertical approach, the surgeon makes the incision which starts in the middle of the abdomen and approaches towards the pubic bone below the navel. The vertical incision gives the surgeon a better access to the uterus and also results in lesser bleeding.
But a vertical incision is used in rare cases, especially when the uterus size is large and it extends up past the navel of the woman. After opening the peritoneal cavity, the lesions are removed by making an incision in the uterus. Once the fibroids are removed, the uterus is repaired.
It takes around six to eight weeks for a patient to recover and get back to the normal life after laparotomy.
Laparoscopy: In this approach, fibroids are located and removed by visualizing the uterus using a laparoscope. The surgeon makes a small incision near the belly to insert a laparoscope, which is a narrow tube fitted with a camera, into the abdominal cavity. The surgeon makes other small incisions in the abdominal wall to insert tiny instruments to perform the surgery.
The fibroids are located and shred into the small pieces using a morcellator. The small pieces are finally removed through the small incisions or, rarely, through an incision in the vagina. Patients who have had a laparoscopic myomectomy recover faster and are also reported to have lower morbidity rate as compared to patients who have had a laparotomy.
Laparoscopic myomectomy uses smaller incisions so it tends to result in less pain, minimal blood loss, and the patient can get back to their normal routine quickly as compared to patients who have had a laparotomy. Usually, a patient takes two to three weeks to recover fully.
Hysteroscopic myomectomy: This technique is suggested by the surgeon in the cases when the fibroids bulge significantly into the uterine cavity. The surgeon gets an access to the uterus by inserting surgical instruments through the vagina and the cervix.
A sterile salt solution is inserted into the uterus to make the uterine cavity expand well enough for a thorough examination of the uterine walls. A resectoscope is then inserted through the vagina to shave the pieces from the fibroid till it gets aligned with the surface of the uterine cavity. The removed tissues are washed out with the help of sterile salt solution.
Hysteroscopic myomectomy patients typically take one to two weeks to recover and get back to their normal daily routine.