Myomenucleation - Information & Specialists

About 20 to 50 percent of all women of childbearing age have uterine fibroids. This makes fibroids one of the most common benign tumors worldwide. Furthermore, not all uterine fibroids cause symptoms or tend to grow rapidly.

If uterine fibroids cause uncomfortable symptoms, doctors can remove them through myomectomy. The size and location of the fibroid determine which method is used.

The most common symptoms caused by fibroids include:

• Miscarriages during pregnancy
• Inability to conceive
• Pain, as well as
• Heavier menstrual bleeding

Before surgery, however, specialists try to treat uterine fibroids with medication. This is because every surgical procedure carries certain risks. This is also true for myomectomy.

Myomectomy is a surgical procedure in which doctors remove fibroids while preserving the uterus @ Peakstock /AdobeStock

The primary goal of myomectomy is to preserve the uterus so that the patient can still become pregnant in the future. The surgical method depends on the number and location of the fibroids in the uterus:

If the fibroids are located just beneath the lining of the uterus (submucosal), doctors can remove them during a hysteroscopy. To do this, they dilate the uterine cavity using a saline solution. They then ligate the protruding fibroids with a loop and remove them. Special instruments are used to grasp the fibroid and gently detach the tissue.

If the fibroids are located in deeper tissue layers—such as intramural fibroids—they are removed via laparoscopy. Subserosal fibroids, which are located on the outer wall of the uterus, can also be removed this way.

Laparoscopy is the surgical method of choice for myomectomy @ Vladislav /AdobeStock

This keyhole procedure (minimally invasive myomectomy) carries a lower risk of bleeding and infection than open surgery involving an abdominal incision. Open surgery can lead to significant blood loss and adhesions. Recovery time is also longer.

The following risks may occur during myomectomy:

• As with any surgery, myomectomy can also result in heavy bleeding.
• Furthermore, wound infections are possible.
• Scarring may also occur in the surgical area.
• In addition, an abdominal incision carries the risk of injury to other abdominal organs, such as the intestines or bladder.
• Special caution is required during pregnancies following myomectomy. In such cases, suture weakness may occur. The previous surgical wound may therefore weaken the uterine wall.

Since the uterus is a delicate organ, the procedure requires special surgical expertise.

Specialists in myomectomy recommend waiting approximately 6 to 12 months before becoming pregnant. The timeframe depends on the size, location, and number of fibroids.

Due to the increased risk of rupture, doctors may recommend a cesarean section at the end of a pregnancy. 

Since uterine fibroids are benign growths, their removal is generally safe. Nevertheless, women with fibroids are prone to recurrence after myomenucleation. This means that new fibroids may form in the future.

The recurrence rate in the first few years following surgery is up to 25 percent. This means that approximately one in four women develops fibroids again after treatment. Viewed another way, however, three out of four women are considered cured following myomectomy.

The surgical treatment of fibroids falls under the purview of specialists in gynecology. Myomectomy specialists are typically gynecologists who perform surgery and work at designated medical centers.

Depending on the findings and suspected diagnosis, other medical specialties may be involved in the preliminary evaluation, such as:

• Surgeons
• Pathologists and 
• Oncologists

The latter are often consulted to rule out a potentially malignant (cancerous) growth.