Women's Health: Uterine Fibroids
Surgical Treatment Options
Surgical options include hysterectomy, myomectomy and myolysis.
Hysterectomy involves complete removal of the uterus.
Approximately 400,000 hysterectomies are performed in the USA each year
for fibroids. Obviously, this treatment is only for women who no longer
wish to have children. A hysterectomy is traditionally performed through
an open abdominal incision. Some women may be candidates for laparoscopic
hysterectomy. Both types of hysterectomy are surgical procedures and
usually require general anesthesia and a 3-4 day hospital stay. Depending
upon the approach used, the recuperation period averages 4-12 weeks.
Because the uterus is removed there is no future risk of cancer
developing.
Myomectomy involves removal of the fibroids with preservation of
the uterus. Left in place, the uterus is generally capable of sustaining
pregnancy. This treatment is generally used for patients with small
fibroids (less than 5 cm in diameter) and less than 5 in total number. It
may be performed by one of three approaches depending upon the location of
the fibroid. Unfortunately, fibroids can recur after myomectomy.
Approximately 10% of patients will require repeat myomectomy or
hysterectomy for adequate control of recurrent fibroids.
- Hysteroscopic myomectomy is used for fibroids just beneath
the inner lining of the uterus (submucosal) that may protrude into the
uterine cavity (intracavitary). The flexible scope (hysteroscope) is
inserted through the vagina and cervix into the uterine cavity. The
fibroid or fibroids are then removed using special tools. This
technique is usually performed while the patient is under general
anesthesia, but requires a much shorter stay and recovery period than
hysterectomy.
- Laparoscopic myomectomy is used primarily for fibroids in the
mid to outer layer of the uterus (intramural and subserosal). Small
skin incisions in the lower abdomen allow the doctor to place the
scope (laparoscope) and operating instruments into the space adjacent
to the uterus. This to allow visualization and removal of the
fibroids. General anesthesia is required as well as a 3-6 week
recovery period.
- Abdominal myomectomy is an open surgical procedure in which
an incision is made in the lower abdomen to allow visualization of the
uterus. A subsequent incision is made in the uterus to allow removal
of the fibroid or fibroids. This procedure usually requires general
anesthesia, a 2-3 day hospital stay, and a 4-6 week recovery period
Myolysis is a newer technique by which the fibroid is destroyed
by placing a probe within it and applying and electrical current or laser
to the tissue. This probe is usually placed through a small skin incision
in the abdomen similar to that used for laparoscopy. Myolysis is less
invasive than hysterectomy and allows preservation of the uterus.
Unfortunately, the technique has not been used widely and currently only a
few centers have a large experience with the technique. Furthermore, there
has been a relatively high rate of post-procedure complications. Finally,
it remains unclear whether the uterus can sustain pregnancy post-myolysis.
More data on myolysis should be available in the next few years, which may
clarify its role in treating fibroids.
Information
in this section is provided by Rhode
Island Hospital's department of radiology, which offers a complete
range of diagnostic and interventional procedures for women, including
uterine artery embolization, a leading treatment for fibroid tumors. Back
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