Different Types of Myomectomy

1. Hysteroscopic Myomectomy

• Best for submucosal fibroids inside the uterine cavity.
• No external incisions; accessed through vagina and cervix.
• Minimally invasive with quick recovery and fertility preservation.

2. Laparoscopic Myomectomy

• Best for small to medium-sized fibroids on outer/middle uterine layers.
• Accessed via small abdominal incisions using a laparoscope.
• Minimally invasive with less pain.

3. Robotic-Assisted Myomectomy

• Best for complex or multiple fibroids.
• Performed using robotic arms for precision and visualization.
• Minimally invasive.

4. Abdominal (Open) Myomectomy

• Best for large, numerous, or deeply embedded fibroids.
• Accessed via a large lower abdominal incision.
• Longer recovery time required.

Key Takeaways

• Type of Procedure: Minimally invasive, surgical.
• Duration: Typically 30 minutes to 1 hour.
• Anesthesia Used: Regional or general anesthesia.
• Recovery Time: 1 to 2 weeks for light activity; full recovery in 2 to 4 weeks.
• Success Rate: Over 90% symptom relief in appropriately selected cases.

Indications of Hysteroscopic Myomectomy

• Heavy Menstrual Bleeding (Menorrhagia): Reduces anemia risk by removing fibroids, causing excessive bleeding.
• Pelvic Pain: Alleviates discomfort from fibroid compression.
• Infertility/Reproductive Issues: Improves embryo implantation by removing fibroids linked to miscarriages.
• Pressure/Fullness: Relieves pelvic pressure caused by large fibroids.
• Abnormal Uterine Bleeding: Normalizes bleeding patterns affected by fibroids.
• Uterine Function and Fertility: Preserves the uterus for future pregnancies; avoids hysterectomy.
• Diagnostic Evaluation: Visualizes uterine cavity abnormalities.

Preparation for Hysteroscopic Myomectomy Surgery

• Consultation and Evaluation: Discuss procedure details with a gynecologist. Disclose medical history, allergies, and medications.
• Preoperative Testing: Blood tests, ultrasound, or MRI.
• Medications: Stop blood thinners as advised.
• Fasting/Hydration: Avoid food/drink pre-surgery.
• Home Preparation: Prepare a recovery space with essentials.
• Support System: Arrange post-surgery assistance.
• Nutrition: Maintain hydration and a balanced diet.
• Mental Preparation: Practice relaxation techniques.

Hysteroscopic Myomectomy Procedure

1. Anesthesia: Administered for comfort.
2. Surgical Site Preparation: Vaginal/cervical sterilization.
3. Cervical Dilation: If needed for instrument access.
4. Hysteroscope Insertion: Guided through the cervix into the uterus.
5. Fluid Distention: Sterile fluid expands the uterine cavity.
6. Fibroid Removal: Visualize and dissect fibroids via hysteroscope. Use bipolar energy to control bleeding.
7. Tissue Removal: Excise infected tissues to prevent recurrence.
8. Completion: Monitor in recovery; discharge same day.

Advantages of Hysteroscopic Myomectomy

• Minimally invasive with quick recovery.
• Preserves uterine function for fertility.
• Lower complication risk vs. open surgery.
• Less postoperative pain.

Risks and Complications

• Cramping/light bleeding.
• Infection or blood clots.
• Uterine perforation or organ damage.
• Adhesion formation or incomplete removal.
• Allergic reactions to anesthesia.
• Increased C-section risk post-procedure.

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Recovery after Hysteroscopic Myomectomy Surgery

Immediate Recovery

• Observe in the recovery room post-anesthesia.
• Discharge same day with possible overnight stay.
• Manage cramping with prescribed painkillers.
• Expect light vaginal bleeding/discharge.

Recovery at Home

• Rest for a few days; avoid heavy lifting/sex.
• Stay hydrated and maintain a nutritious diet.
• Attend follow-up appointments for stitch removal.

Longer-Term Recovery

• Return to work within 1-2 weeks.
• Gradually resume physical activity.
• Menstrual cycles may temporarily disrupt.
• Discuss fertility plans with your doctor.