Fibroid Surgery


Uterine fibroids are quite common with 25-30% of women having a fibroid. Fortunately most fibroids never lead to any problems. The vast majority of my patients with fibroids do not need any type of treatment, only reassurance. In the minority of women who have problems, some of the common complaints that result from problematic fibroids include heavy and uncomfortable menstrual periods, pelvic and abdominal pressure due to uterine enlargement, having to urinate more frequently, miscarriage.

In some cases women with fibroids (also called myomas) are encouraged to undergo a hysterectomy when they actually want to conserve their uterus. It is very unlikely that if you have fibroids in your uterus that a conservative approach cannot be offered to you. If your physician only offers you a hysterectomy for your uterine fibroids and you still want to have a child then you should seek a second opinion.

Myomectomy most often describes making an incision in the abdomen (similar to a cesarean section). The uterus is then opened and the fibroids are shelled out. The uterus is then carefully reconstructed. This technique has been around for decades and is an excellent option that should not compromise fertility in most cases. In some cases Drs. Bateman and Williams can do the myomectomy through a small incision, called a mini-laparotomy. This may allow discharge home the same day and a hospital stay is unnecessary.

Some fibroids reside in the uterine cavity or have grown into the uterine cavity which allows a minimally invasive approach called hysteroscopy. This is a wonderful option when available because it involves no incisions at all. During a hysteroscopic myomectomy a camera mounted on a 5 mm wide lens is inserted through the vagina and cervical canal into the uterus. Through the end of the lens specialized instruments are used to remove the fibroid(s). Some practitioners do not offer a hysteroscopic approach to amenable fibroids. This is usually due to limited training but may also be because their operating room does not have the specialized equipment required to offer this technique.

In some circumstances, we can offer a laparoscopic approach to myomectomy. This means that with a few 5 mm incisions in the abdomen the fibroids can be removed during a same-day procedure. No larger incision is required and the recovery is less than a week. Most physicians do not offer a laparoscopic approach to amenable fibroids. This is usually due to limited training but may also be because their operating room does not have the specialized equipment required to offer this technique.

Uterine Artery Embolization for fibroids (UAE) is another excellent minimally invasive technique for treating fibroids. However, radiologists and reproductive endocrinologists, fertility specialist, agree that this is not a good option in someone who wants to get pregnant in the future. There is some information that the embolization can compromise ovarian function. We do not recommend this technique unless you do not want to have a pregnancy in the future. To learn more about UAE go to: http://www.crlradiology.com.