Surgical Fibroid Treatment

Uterine fibroids are very common amongst women of childbearing age. In fact, between 50% and 80% of all women will develop at least one fibroid at some point during their lives. For most women, fibroids are not a huge problem, and cause relatively few symptoms.

However, for some women uterine fibroids are associated with painful and distressing symptoms, including heavy menstrual periods, abdominal cramping, and even infertility. If your uterine fibroids are causing you particularly painful symptoms, you may want to consider having them surgically removed. While medicinal treatments are available, these often just treat the symptoms associated with fibroids. For permanent relief, there are a number of effective surgical treatments available for uterine fibroids.

Traditional Surgical Treatments

There are a few surgical treatments that are traditionally used to remove uterine fibroids. These traditional techniques tend to be the most effective, but also require longer recovery time and more painful side effects.

Hysterectomy

A hysterectomy enables the surgeon to remove your uterine fibroids by removing your entire uterus. This is a permanent way of removing your fibroids, however, you will be unable to get pregnant or bear children after a hysterectomy.

Hysterectomy procedures may also involve the removal of the fallopian tubes, ovaries, and cervix. Hysterectomy is the most common treatment used for uterine fibroid removal, and accounts for 30% of all fibroid treatments.

There are three different approaches to hysterectomy:

• Vaginal Hysterectomy: An incision is made in the vagina to remove the uterus. Although this procedure leaves no scars on the skin, there may be complications such as bleeding, infection or injury to intestines and bladder.
• Abdominal Hysterectomy: The uterus is removed through an incision in the lower abdomen. Complications are the same as in the case of vaginal hysterectomy.
• Laparoscopic Hysterectomy: The uterus is removed through four incisions on the abdomen. A small scar remains on the skin and complications and injuries to internal organs and bleeding may occur.

Who Should Get a Hysterectomy?

Hysterectomy is only recommended for those women who have a very enlarged uterus due to the growth of their uterine fibroids. Hysterectomy is generally suggested once the uterus grows to the size that it would be after 12 weeks of pregnancy. Hysterectomy is also performed when uterine fibroids appear to be cancerous.

How is a Hysterectomy Performed?

Abdominal hysterectomies are performed in hospital under general anesthetic. An incision is made in your abdomen and a surgeon removes your entire uterus. If your fibroids are smaller, than you may have a vaginal hysterectomy, in which the uterus is removed through an incision in the vagina. Recovery from a hysterectomy generally takes about six to eight weeks.

Myomectomy

Myomectomy involves the surgical removal of uterine fibroids without the removal of the uterus. It is performed in hospital under general anesthetic. Though myomectomy is often successful, fibroids that have been removed can grow back in the future.

Myomectomy can be performed several different ways depending upon the size, number and location of the fibroids in the uterus. There are basically three type of myomectomy:

• Abdominal Myomectomy: A major surgical procedure in which the fibroids on the muscular wall of the uterus are removed through an incision in the lower abdomen.
• Laparoscopic Myomectomy: An effective surgical procedure to remove pedunculated subserosal fibroids. Complications may include injuries to the internal organs and bleeding. Moreover, the uterus is usually left weaker after surgery. Therefore, abdominal myomectomy is a better proposition for women who are planning on becoming pregnant in the future.
• Hysteroscopic Myomectomy: Only submucosal fibroids can be removed through this procedure, during which a laparoscope is inserted into your uterus that will guide your surgeon while a resectoscope shaves parts of the fibroids off of your uterus.

Who Should Have a Myomectomy?

Women with smaller uterine fibroids are the best candidates for myomectomy. Myomectomy is also appropriate for those women who would like to get pregnant in the future. However, myomectomy cannot guarantee fertility and only 50% of those undergoing the procedure experience a future pregnancy.

How is a Myomectomy Performed?

During a myomectomy, the surgeon makes a horizontal or transverse incision across your pelvic line. After opening the outer, muscular layer of the uterus, any visible fibroids are removed. The uterus is then repaired using sutures. Myomectomy can also be performed using laparoscopic techniques. This requires four small incisions on either side of the abdomen. A small camera is then inserted into the uterus in order to guide the removal of the fibroids. The fibroids are cut into small pieces and removed through the abdominal incisions.

New Surgical Treatments

In recent years, a few new surgical treatments for uterine fibroids have been introduced. These treatments require less recovery time and are less involved than traditional treatments. However, because they are relatively new treatments, it can be difficult to find surgeons skilled in these operations.

Hysteroscopic Resection

Hysteroscopic resection allows uterine fibroids to be removed without making any surgical incisions. This procedure is particularly suitable for those women who would like to bear children in the future.

Who Should Get Hysteroscopic Resection?

Hysteroscopic resection is particularly suited to those women with submucosal fibroids or with fibroids that are less than ten centimetres in diameter.

How is Hysteroscopic Resection Performed?

Hysteroscopic resection is performed in hospital under general anesthetic. A thin telescope is inserted through your cervix and into your uterus. A wire, electrical knife, or laser is then fed into your uterus. Using the telescope as a guide, the surgeon uses the wire, knife, or laser to remove the fibroids. The uterus is then repaired with sutures. This procedure only requires one night’s stay in the hospital and between one and two weeks recovery time.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization is a procedure used to shrink the size of uterine fibroids and reduce the severity of symptoms. It involves no surgical incisions and can be performed under local or general anesthesia.

Who Should Get Uterine Fibroid Embolization?

Uterine fibroid embolization is particularly suited to women who have large, symptom-producing uterine fibroids. Embolization helps to shrink the fibroids and reduce the pain and bleeding that they can cause. Women with pedunculated fibroids should not undergo uterine embolization, as this can cause the fibroids to detach from the uterus and float around in the abdominal cavity.

How is Uterine Fibroid Embolization Performed?

Uterine fibroid embolization is a relatively non-invasive procedure. A catheter is guided through an incision made in your groin, and into the blood vessels that supply your uterus. Small plastic particles are then pushed through the catheter. These work to block the blood vessels, causing the fibroids to shrink and die. Recovery from the procedure takes about one week

Deciding on Surgery

A number of factors are considered while selecting the most appropriate surgical procedure to deal with fibroids. One of the most critical questions that requires a lot of consideration is whether surgical treatment of fibroids will affect the a woman’s fertility.

Studies have revealed that hysterectomy provides excellent relief from the symptoms of fibroids. Yet, completely removing the uterus will mean that pregnancy is no longer a possibility. Therefore, women who wish to become pregnant in the future will need to opt for myomectomy.

With myomectomy, the relief is short-term and the risk of recurrence of fibroids is quite high. Moreover, between 11% to 26% of women require a second surgery after their initial surgical procedure. In addition, abdominal and laparoscopic myomectomy carry varying degrees of risk for uterine rupture during pregnancy or labour. Despite these disadvantages, myomectomy makes future childbearing possible.

A number of new treatments, such as thermoablative techniques with magnetic resonance imaging-guided therapy (which includes percutaneous laser ablation, cryomyomlysis and focused ultrasound treatment), are being investigated.