Surgical Treatments for Fibroids
There are a variety of surgical treatments for fibroids. The type of treatment depends on a variety of factors including the size, location and number of fibroids, medical history, and childbearing status. Surgeons at the Magee Fibroid Center choose minimally invasive techniques whenever possible.
Myomectomy is procedure that removes visible fibroids from the uterine wall. Myomectomy leaves the uterus in place and may preserve the ability to have children. There are several ways to perform a myomectomy – abdominal, hysteroscopic, or laparoscopic. While a myomectomy may successfully control symptoms, fibroids may grow back after several years.
Laparoscopic myomectomy a minimally invasive procedure performed under general anesthesia, involves inserting a laparoscope near the belly button and making small incisions in the lower abdomen. The fibroids are removed and the uterus is closed using laparoscopic technique. The patient typically goes home the same day; the average recovery time is about two weeks.
Hysteroscopic myomectomy is typically used for removal of fibroids located just under the lining of the uterus, which are protruding into the uterine cavity. The doctor inserts a hysteroscope into the uterus through the cervix and removes the fibroids using special surgical tools fitted to the scope. This is typically an outpatient procedure, and the patient normally returns home the same day.
Abdominal myomectomy is performed under general anesthesia, and requires an incision in the abdomen to access the uterus. Another incision is made in the uterus to remove the tumor. This procedure requires admission to the hospital.
Hysterectomy is the surgical removal of the uterus. Various techniques are used to remove the uterus, and at times, other reproductive organs. Hysterectomy is usually recommended when the fibroids are causing symptoms, when they have grown rapidly, or when the fibroids are of large size, usually the size of a grapefruit. The advantage of hysterectomy in the treatment of fibroids is that it provides a true "cure.” This option is only for women who are not planning future pregnancies.
laparoscopically assisted vaginal hysterectomy (LAVH)
In a laparoscopically assisted vaginal hysterectomy (LAVH), a laparoscope is inserted near the belly button through eraser-sized incisions and is used to view the pelvic organs. Surgery is performed through tiny incisions in the abdomen, and the uterus is removed through the vagina. This typically requires only an overnight stay in the hospital.
Vaginal hysterectomy is a less invasive technique for the surgical removal of the uterus; however, some disease processes make the vaginal approach difficult or impossible. During a vaginal hysterectomy, the uterus is removed through the vagina. An abdominal incision is not necessary. A total vaginal hysterectomy (THV) is the removal of the uterus and cervix through the vagina. A total vaginal hysterectomy and bilateral salpinoogpherctomy (TVH-BSO) is the removal of uterus, both fallopian tubes, and ovaries through the vagina. Hospitalization is required for this procedure.
Abdominal hysterectomy is usually recommended if the fibroids are large or if there are other conditions such as large ovarian cysts, extensive endometriosis, or unexplained pelvic pain where the gynecologist needs to closely examine the pelvic organs. With an abdominal hysterectomy, the uterus and, sometimes other pelvic organs, are removed through a surgical incision in the abdomen. An abdominal hysterectomy is the most extensive surgical treatment for fibroids. It typically requires several days in the hospital and several weeks recovery time. There are various types of abdominal hysterectomies depending on the organs that are removed:
- Total abdominal hysterectomy (TAH) is removal of the uterus including the cervix (lower portion of the uterus).
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) is removal of the uterus, cervix and both fallopian tubes and ovaries.
- Subtotal abdominal hysterectomy or supracervical abdominal hysterectomy leaves the cervix intact (only the upper portion of the uterus is removed through an incision in the abdomen).