A fibroid is a firm, muscular growth arising from the womb (uterus). A fibroid can be almost any size, arise from any portion of the uterus and there can be one or many at the same time. Fibroids are very common and typically are not cancerous.
Read more about fibroids (myomas)
What is fibroid surgery?
Fibroid Surgery (myomectomy my-o-mec-to-me) is a surgical procedure to remove uterine fibroids (myomas) from the uterus, thereby preserving the uterus. This approach to managing fibroids is typically suitable for women who prefer to preserve their uterus for any reason, including those who are planning pregnancy.
When is fibroid surgery performed?
How is fibroid surgery performed?
To perform Fibroid Surgery, a general anaesthetic is required. The abdomen and pelvis are swabbed with antiseptic cleaning solution and sterile drapes are applied to reduce the risk of infection. A urinary catheter is placed to drain the bladder. An instrument (called a uterine manipulator) is placed through the cervix and rests in the uterus.
The specific way Fibroid Surgery is undertaken depends on a number of factors, including the type of fibroid, its size, location and how many fibroids there are. The different ways to perform Fibroid Surgery include:
- Hysteroscopic fibroid surgery – A hysteroscope is a thin surgical instrument that inspects the inside lining of the uterus. It can be used to remove fibroids impacting on the inside lining of the uterus (called the endometrium). Read more about Hysteroscopic Resection of Uterine Abnormalities.
- Robotic-Assisted fibroid surgery – A minimally-invasive surgical robot is controlled by Dr Dunn with very fine precision to excise the fibroid from the uterus. Like laparoscopic surgery, Robotic-Assisted Surgery uses 5-10mm incisions to access the internal organs and perform the procedure. Sometimes a mini-laparotomy (skin incision of 5-10cm) is needed to extract the fibroid. Read more about Robotic-Assisted surgery
- Laparotomy – A larger skin incision (approximately 15-20cm and typically the same as a Caesarean Section incision) is made on the abdomen to expose the internal organs. The bigger incision allows the Fibroid Surgery to be performed using hand-held instruments. Read more on laparotomy
Irrespective of the way in which fibroid surgery is performed, the process is similar. The layers of uterus are carefully dissected away from the fibroid so it can be extracted. The defect or hollow from where the fibroid was retrieved is closed over with absorbable sutures. When there is more than one fibroid, there may need to be multiple incisions made into the uterine wall to retrieve to the fibroids.
Because fibroids are very rigid and firm, they often need to be morcellated (or cut up into smaller pieces). This process is performed using a contained extraction technique where the fibroid is morcellated into smaller pieces within a medical extraction bag. This technique securely contains the tissue being removed to prevent spillage or contamination. This means that a large or multiple fibroids can be morcellated and retrieved through the small minimally-invasive skin incisions on the abdomen.
Frequently Asked Questions
How do I know if I can have a laparoscopic myomectomy?
It depends on the number, size and position of the fibroids as well as the surgeon’s experience and preference. The rule of thumb in most cases is up to 5 fibroids no bigger than 8 cm each. Each case is then assessed individually, on its own merits. For example, a single fibroid with a 10 cm diameter can be removed laparoscopically as well as six or seven small ones; a large fibroid attached to the uterus by a small stalk is easier to remove than a smaller fibroid embedded into the uterine wall and near large arteries.
Do I need a myomectomy if I have fibroids?
Not necessarily. Most fibroids do not require any treatment. Treatment is indicated either when fibroids symptoms such as bleeding and pressure are present or when fibroids are too big or have grown too fast. Each case is different and things may change over time. You should always start with a discussion with your doctor.
I have fibroids and I am planning to fall pregnant. Do I need to have them removed?
Again, not necessarily. They only need to be removed if they are making you infertile, causing miscarriages or you are experiencing bleeding or pressure symptoms separate from fertility issues.
How do I know if I should I have a myomectomy or a hysterectomy?
Both operations are used to treat fibroids. A myomectomy removes the fibroids and preserves the uterus while a hysterectomy removes the whole uterus. The two options work well to remove the fibroids and reduce symptoms. Several factors can influence the decision, but ultimately it comes down to the individual woman’s choice. A woman may choose to preserve the uterus because she wants to preserve her ability to fall pregnant, because she still wants to have periods or simply because of personal preference.
Are there any advantages to having a hysterectomy?
Removing the uterus is guaranteed to stop excessive bleeding as there are no more periods. In addition, it avoids the growth of other fibroids requiring more surgery in the future. It is seen as a more definitive treatment.
What are the advantages of a myomectomy?
The most obvious is the preservation of a woman’s fertility and the ability to fall pregnant. It should be chosen by women who intend to have children or want to keep their options open, as well as by any woman who wants to preserve the uterus.
What are the surgical risks of a myomectomy?
The most important surgical risks include:
Bleeding
Myomectomies sometimes bleed more than hysterectomies, particularly if multiple incisions are required to remove many fibroids. If the bleeding is excessive, it may require a blood transfusion. This happens in about 1% of cases.
Infection
This is a possibility in any surgical procedure. Surgeons take several measures to avoid infection including using sterilized instruments, gowns, gloves, etc. and using antibiotics. A surgical infection may require prolonged hospitalization and the use of more antibiotics.
Damage to other organs
As with any procedure done in the pelvis, there is a possibility of injury to the bowel, bladder, ureter and large vessels. All care is taken to prevent it from happening. If it does, it may be a small and simple to fix situation like a small cut to the bladder, or a more serious complication like a perforation to the bowel. Odds of a serious complication are in the order of 1/1000.
Hysterectomy
Whenever the surgeon sets up to perform a myomectomy it may be the case that it ends up in a hysterectomy. This is a rare event, in the order of 1/300 procedures. The most common reason is that the uterus starts to bleed and there is no way of stopping the bleeding other than doing a hysterectomy. The hysterectomy is then seen as a life saving measure. This possibility needs to be discussed before the procedure. Although rare, it may have serious emotional consequences for the woman.
Adhesions
Operations cause scars. External scars can be seen on the skin, internal scars present in the form of adhesions or fibrous connections between internal organs. When formed between the ovaries and fallopian tubes or within the uterus, these internal scars may interfere with fertility.
Uterine wall “weakness”
The uterine scar, where the incision to remove fibroids was made, may create a point of tissue thinning or fibrosis. This can become a problem during labour as it may break (uterine rupture). Depending on the size and position of the scar, your surgeon may recommend that you have a caesarean section if you fall pregnant.
Can I fall pregnant after a myomectomy?
You certainly can and this is one of the most common reasons why a myomectomy is chosen instead of a hysterectomy.
Do I need to have a Caesarean section if I become pregnant after having had a myomectomy?
It depends on the size and position of the incision made on the uterus to remove the fibroids. If the fibroid(s) was big enough to warrant surgery, the odds are that you will need a caesarean. The best person to assess this need is the surgeon who performed the myomectomy, so feel free to ask them about this concern.
How long do I need to stay in hospital?
Usually one or two days after a laparoscopic myomectomy and two to three days after an open myomectomy.
How long do I need to recover form the operation?
Return to work and everyday activities happens between two and three weeks for a laparoscopic myomectomy and four to six weeks after an open myomectomy.
Are my ovaries going to be removed during the myomectomy?
No. The ovaries are preserved both in the case of a myomectomy and of a hysterectomy for fibroids. Fibroids are uterine nodules and do not interfere with the ovaries.
Our Before & Afters
FAQ
HOW LONG DOES FIBROID SURGERY TAKE?
Fibroid surgery duration is influenced by the size, location and number of fibroids.
Hysteroscopic myomectomy will typically take about 30 minutes and laparoscopic / robotic myomectomy and abdominal myomectomy will typically take 2-3 hours.
CAN I FALL PREGNANT AFTER FIBROID SURGERY?
Yes you can.
It is recommended you delay falling pregnant by about 4-6 months to allow time for the uterus to heal sufficiently. Reliable contraception for this period of time is recommended.
WOULD I BIRTH BY CAESAREAN AFTER FIBROID SURGERY?
Typically a caesarean birth is recommended.
This is because there may be weaknesses in the uterine wall following fibroid surgery that do not adequately withstand the contractions of labour. These sites of weakness may separate and contribute to uterine dehiscence and rupture, which is an obstetric emergency.
WILL I STILL GET A PERIOD AFTER FIBROID SURGERY
Yes. Removal of a uterine fibroid is not anticipated to have an impact on ovarian function or periods. Except however, that period volume and pain may be significantly less following fibroid surgery. Fibroid surgery does not lead to menopause.
HOW DO I DECIDE ON HYSTERECTOMY OR FIBROID SURGERY?
Both hysterectomy and fibroid surgery are management options for fibroids. Sometimes the location, number and size of fibroids makes fibroid surgery unachievable because there may be inadequate uterus muscle remaining once the fibroids are removed. Similarly, there may be situations where hysterectomy may be technically complex.
When either fibroid surgery or hysterectomy is appropriate to your circumstances, deciding between these procedures is a personal choice. It is determined by how acceptable each procedure is to you, what the goals of treatment are and whether you have a preference to conserve your uterus (for any reason you deem important).
For women who do not wish to conserve their uterus, then hysterectomy may be more acceptable. Fibroid surgery may be preferrable to women who wish to conserve their uterus for any reason, including future pregnancy intentions, or for those who wish to avoid the specific risks of hysterectomy,
WHAT ARE THE BENEFITS OF FIBROID SURGERY?
Benefits of fibroid surgery include:
Improvement in fibroid symptoms with the benefit of conserving the uterus and all of its potential functions.
Ascertaining a diagnosis of the type of fibroid. Rarely, a fibroid can be cancerous and finding this out by removing the fibroid can help arrange timely treatment.
Reduce heavy periods
Reduce painful periods
Reduce sensation of pressure, fullness or bloating
Reduce bowel and bladder symptoms (like frequent urination or difficulty passing a bowel movement)
Reduce pelvic pain symptoms
Address subfertility and difficulty falling pregnant
Reduce fibroid related pregnancy complications including including miscarriage and preterm birth
WHAT ARE THE RISKS OF FIBROID SURGERY?
Recurrence of fibroids. Surgery can only remove existing fibroids. It does not prevent them recurring.
Hysterectomy is needed if bleeding occurs from the site of fibroid surgery and cannot be controlled with alternative measures. A hysterectomy means carrying a subsequent pregnancy is not possible.
Future caesarean section is typically recommended as there is disruption to the layers of the uterus, which may be sites of weakness during a subsequent labour.
Inadequate resolution of pressure, bloating and pain symptoms attributed to fibroids.
Ongoing subfertility or difficulty falling pregnant
General surgical risks include infection (of any organ from the skin to the pelvis), bleeding, injury to adjacent organs like the bladder, ureters (urine tubes that connect the kidney and bladder), bowels and nerves.
Complications from surgery can be minor with little to no impact on your quality of life, however they can also be severe – where there maybe a deterioration in your quality of life as a result. Readmission to hospital or further surgery, including complex surgery to reconstruct the affected organ may be required. Death, whole body or permanent disability is a rare complication of elective gynaecological surgery.
WHAT ARE MY OPTIONS?
You may wish to wait and see how your manage with your fibroids (conservative approach).
This might include repeat ultrasound or MRI to evaluate any change in size, characteristics or number of fibroids.
A blood test called LDH may be elevated in cancerous fibroids however it is not accurate enough to predict cancerous fibroids. LDH blood test is used together with the ultrasound or MRI, to help inform your choices around managing fibroids.
You may wish to have a hysterectomy to manage symptoms related to fibroids, when you no longer wish to conserve your uterus. This is considered definitive treatment, as fibroids and their associated symptoms cannot return after a hysterectomy.
Uterine artery embolisation is a non-surgical technique offered by interventional radiologists in some regions. This procedure is not offered by Dr Dunn but he will coordinate you having this treatment if you wish. A guide-wire and a very fine tube is inserted into a blood vessel in the groin and then using X-ray is guided into the blood vessel feeding the uterine fibroid. A fluid containing micro-particles is injected through the very fine tube and into the fibroid blood vessel. This causes the vessel to be blocked, therefore depriving the fibroid of its blood supply.
HOW LONG IS RECOVERY AFTER FIBROID SURGERY?
Recovery from fibroid surgery is typically well tolerated. Adequate pain relief will be prescribed to control pain both in hospital and at home. The 5-10mm skin incisions from ‘key-hole’ surgery will be tender for a few days. A larger incision of 5-20cm (laparotomy) will be tender for about a week.
Your uterus will have stitches in it where the fibroid/s were removed and these can cause pelvic aching and pain.
You might experience bothersome shoulder tip pain that will ease in the days after surgery. You will be able to eat and drink as usual. Your bowels might be slower than usual and can be eased with stool softeners (like Movicol® or Coloxyl®). You are unlikely to notice any difference in bladder function, but any changes are typically temporary and mild.
Hospital stay: If you have hysteroscopic fibroid surgery, you may go home the same day as your procedure if you feel well and recover at home. If you had ‘key-hole’ fibroid surgery, you will typically stay in hospital for 1-2 nights. If you have a laparotomy (larger skin incision), you will likely have 2-3 nights in hospital.
Returning to work: This depends on the type of work you are returning to. After fibroid surgery you can return to office-based work usually within 2 weeks after minimally invasive laparoscopic surgery and after 4 weeks following a laparotomy. More physically demanding work may require longer recovery of around 6 weeks. Consider if there are alternative, less-physically demanding roles you can do to ease your return to work.
Driving and travel: Typically, you can drive 2 weeks after your minimally invasive surgery. Always check with your vehicle insurance provider and comply with any instructions they provide you. You typically need to wait at least 2 days before flying. Check with your airline so you can safely time your surgery and travel.
Pregnancy: You should avoid falling pregnant for at least 4-6 months depending on your specific type of fibroid surgery. This is to allow the uterus to heal sufficiently before pregnancy.
Intimacy, exercise and other activities: You should defer penetrative intercourse for 2 weeks and until any abnormal vaginal bleeding has settled. You can resume your usual physical activity and exercises 2-3 weeks after your surgery.
Please remember your recovery is individual. Each day following surgery you can expect to have made some improvement in how you feel. Dr Dunn will happily discuss your specific recovery circumstances.
Please read more about recovery in the Patient Information pages
