Alternatives to a hysterectomy
Myomectomy means the surgical removal of just the fibroid; leaving the uterus in place. A myomectomy can be performed either through a large open incision in the abdomen or through two minimally invasive techniques: laparoscopic myomectomy, which requires a very small incision, or hysteroscopic techniques, which require no incisions.
2. Abdominal Myomectomy
The abdominal myomectomy is the most common method of removing fibroids and preserving the uterus. It is done either by making a five-inch incision in the abdomen extending from the pubis to the umbilicus or a transverse incision in the lower abdomen (called a bikini incision because a bikini will cover the scar). The uterus is exposed and the fibroids are evaluated and removed. Only the most highly-trained surgeons will have the skills to remove these fibroids and sew the uterus back together without damaging the overall integrity of the valuable organ. The procedure takes one to two hours depending on the number and size of the fibroids, and most women remain in the hospital for two to three days. Many women are told a hysterectomy is safer than a myomectomy, that there is less bleeding, or that there could be cancer present. However, this is not supported by current literature.
3. Laparoscopic Myomectomy
Laparoscopic surgery is usually performed as an outpatient surgery under a general anesthetic. It has revolutionized surgery as it causes less pain, requires a shorter hospital stay, allows for faster recovery, and is very safe when performed by a skilled surgeon.
This alternative to a hysterectomy differs from the large "open" incision in several ways:
- a laparoscope is a slender telescope (with a camera) that is inserted through the navel to view the pelvic organs;
- two small half-inch incisions are made in the lower abdomen;
- the instruments that will cut out the fibroids cauterize the blood vessels, sew the uterine incision closed, and are then passed through these two small incisions.
Once the fibroids are cut out of the uterus, the opening is sewn closed and the fibroids are removed in pieces (all done through small incisions). The procedure takes one to three hours and requires special training and expertise. It is often a good idea to get a second opinion from a gynecologist who performs laparoscopic myomectomies on a regular basis. Most patients go home that day or the next and are back to work in one to three weeks.
The da Vinci robot is the most advanced equipment for laparoscopic surgery. Different than regular laparoscopic surgery, the robot uses similar instruments through similar minimally invasive incisions; however it is different because it allows for more dexterity, finesse, strength, and easier suturing and removal of fibroids (some of which are larger and would otherwise need to be removed via incision).
4. Hysteroscopic Resection
Internal fibroids, or myomas, are located inside the uterus in the endometrial cavity. They can be diagnosed by an ultrasound but a better tool is the sonohysterography, using the hysteroscope, which is like the laparoscope – a telescope with a camera in it which projects the images on a TV screen. It is inserted through the vagina, into the cervix and into the endometrial cavity. Small wire-like instruments are then passed through the hysteroscope to remove the fibroid. There is a 24-hour recovery and little to no pain.
5. Selective embolization
Selective embolization, also called uterine fibroid embolization (UFE), is a newer approach to treating fibroids without removing them. Performed by an interventional radiologist with the patient awake but relaxed on medications, a catheter the size of a spaghetti strand is placed into a groin artery, and using x-rays, is threaded up to the blood vessels which "feed" the fibroids. Very small particles are then released through the catheter to block the blood supply to these fibroids, causing them to shrink and die. The procedure takes one to three hours with the patient going home the next day.
6. Focused Ultrasound
The newest non-invasive treatment for fibroids, an MRI is used to locate the fibroids while high intensity sound waves are directed at, and destroy, them (similar to sound waves destroying gall stones).
7. Endometrial Ablation
This procedure ablates, or removes, the lining of the uterine cavity and can be done through a variety of techniques, including Novasure, balloon ablation, HTA and cryoablation. With a 90 percent success rate of stopping or decreasing the monthly flow, it is recommended for women who have completed their childbearing. Recovery is usually within 24 hours.
If you need treatment for fibroids and prefer medications, there are many non-surgical treatment options, including Lupron, progesterone, homeopathy and Chinese medicine.
Research your options very carefully
With the addition of the da Vinci robot, hysterectomies have gotten easier to perform with better, faster recoveries. While techniques to help avoid hysterectomies have improved and increased in availability, not all physicians are familiar with the techniques listed above, nor do they have the proper training. It is imperative that patients learn about all of their options and be given a chance to discuss them with a physician that will help guide them toward the procedure that is best for them.
More on hysterectomy and fibroids
To learn more about alternatives to hysterectomies and fibroid treatments, visit www.scottsdaleobgyns.com.