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Myomectomy - surgery to remove uterine fibroids

A myomectomy is a surgical procedure that deals with the removal of myomas. There are several approaches and techniques for dealing with leiomyomas. This page will discuss the most common technique.

Uterine Leiomyoma (fibroids)
Here you will find more information about uterine leiomyomas.

The most common method for surgically treating leiomyomas is the laparotomy or minilaparotomy with excision of the tumor(s). The incision is similar to that made to perform a cesarean section, though usually much smaller. Incisions are made on the uterus where the fibroids are located. The normal muscle is separated from the fibroid using gentle traction and an electrosurgical device. Care must be taken to minimize bleeding because the normal uterine muscle is highly vascularized and will bleed easily when disrupted. Surgeons attempt to remove as many of the fibroids through the anterior aspect of the uterus (side closest to the bladder). This is done to reduce the risk of the fallopian tubes and intestines scaring to the incision and interfering with fertility. This risk is increased with incisions made to the posterior aspect of the uterus, but can be minimized with careful surgical technique. The incisions are also closed in such a manner as to reduce the risk of adhesion (scar tissue) formation.

Fibroid following a myomectomy.
Note the well defined border and solid appearance.
Click the image for larger view.

Dr. Zeringue has extensive experience with myomectomy procedures and is frequently called in to the operating room by other surgeons for assistance with difficult cases. You will want someone with this level of experience when you are undergoing fertility surgery. It is imperative to protect the uterus and tubes during this operation.

Following surgery, the uterine tissue undergoes remodeling and healing. After this process the uterus can take on a normal appearance and function. Depending on the amount of normal muscle that is disrupted by the surgery or displaced by the fibroid, the physician may recommend that labor be avoided in favor of a cesarean section. As the muscle heals scar tissue can form. This scar is prone to rupture during labor. Not all myomectomies require subsequent cesarean section for delivery so be certain you understand your situation after the surgery.

The majority of myomectomies can be performed in our outpatient surgical center under the extended observation program. This allows patients to maintain nursing care overnight without actually being admitted to the hospital. The recovery period at home is often quite brief.

Uterine artery embolization is frequently discussed with patients by interventional radiologists. Care must be taken with infertility patents. The long term effects on the uterine muscle and subsequent ability to carry a pregnancy to term is not fully understood. The embolization procedure damages the tissue around a fibroid as well as the fibroid itself. This may be a great option for patients desiring symptomatic relief from fibroids but this option is best avoided by women desiring to become pregnant in the future.

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California IVF: Davis Fertility Center.  Providing infertility and IVF services to the Sacramento and Roseville area.  Services include IVF, inseminations - IUI, male and female infertility, PGD, ICSI, and much more.