In which patients is myomectomy difficult and in which ones it is easy?

​Myomectomy is based on the surgical removal of uterine fibroids one by one under general anesthesia. Myomectomy is usually performed as open surgery on the abdomen, but can also be performed laparoscopically or hysteroscopically. If only one or several superficial fibroids are detected in the uterus on the MRI examination, myomectomy may be an appropriate treatment method. However, as the number of fibroids increases, the myomectomy becomes more difficult, the risks of the operation increase, the probability of recurrence becomes higher and thus, the overall results are no longer satisfactory for the patient. ​ ​

 

Patients who are most suitable for myomectomy are those with subserous (outward growing) fibroids that are attached to the uterine surface with a small stalk. Such fibroids can be easily removed with myomectomy without harming the uterus much, just like picking up a fruit from a tree. Similarly, fibroids growing towards the inner surface of the uterus (submucosal) can also be removed by endoscopic (hysteroscopic) myomectomy if they are smaller than 2-3 cm in size. However, myomactomy is not very suitable for large, sessile or multiple submucosal fibroids. ​ ​

 

The most difficult type of fibroids for myomectomy are intramural fibroids especially if they are multiple and large. In such fibroids, embolization therapy should be the first choice, myomectomy should be performed only selected cases. Because in myomectomy, a separate incision and surgery is required for each fibroid, and in such patients, the surgery takes longer, blood loss is more, and pain and other complications are more common after the surgery. Also, the hospital stay after myomectomy may be even longer than hysterectomy in some patients. In patients with multiple fibroids, In such patients, it is difficult to surgically remove all fibroids, and it is also difficult to determine which fibroid is causing the patient's complaints.

 

In conclusion, intramural and multiple fibroids are not favorable for myomectomy. in such patients, even if the surgery is performed successfully, up to 60% of the patients have recurrent complaints and second or third myomectomies and sometimes hysterectomy may be required. ​ ​

 

Video: Comparison of embolization and surgery, Prof Dr Saim Yılmaz