What is more common, the open myomectomy or the laparoscopic myomectomy?

 

There are two different types of myomectomies: open myomectomy and laparoscopic myomectomy. Dr. Suzanne Slonim tells us which one she thinks is more common.

“I’m fairly certain that the laparoscopic myomectomy is more common. I’m not a gynecologist, I don’t do the procedure, but I think it is laparoscopic.”

 

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What is a myomectomy?

 

While uterine fibroid embolization is a less invasive procedure performed by an interventional radiologist, a myomectomy is performed by a gynecologist and is slightly more invasive. Dr. Suzanne Slonim explains the procedure further.

“A myomectomy is a procedure where the gynecologist usually laparoscopically puts ports into the pelvis, it’s done under general anesthesia, and makes a small incision in the muscle of the uterus, and sort of scoops out the fibroid and takes it out. Now if it’s too big to come out through the port hole, they can do, they can grind it up essentially, and make it small enough to fit out through the port.”

 

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When is a myomectomy better than a Uterine Fibroid Embolization (UFE)?

 

Depending on the size, location, and type of your fibroids, there may be different treatment options that will work best for you. Dr. Suzanne Slonim, M.D., explains when a myomectomy may be the better choice.

“A myomectomy would be preferred if you had a single large fibroid, particularly if it were in the front of the uterus, easy to get to, in front, or side that wasn’t too deep into the tissue, that would be the ideal candidate for a myomectomy.”

See Dr. Linda Hughes’ answer to this question.

 

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What is a myomectomy? What are the challenges with a myomectomy?

 

While Uterine Fibroid Embolization (UFE) is a less invasive procedure performed by an interventional radiologist, a myomectomy is performed by a gynecologist and is slightly more invasive. Dr. Suzanne Slonim, M.D., explains the challenges with undergoing a myomectomy.

“There’s a few challenges, and again, I’m not an OB/GYN, I don’t do the procedure but, the more fibroids you have, the more extensive the surgery has to be and the longer it takes. The position of the fibroids can be very challenging to get to from the laparoscopic approach and the deeper fibroids can be difficult for the gynecologist to get to, and essentially have to go deeper into the uterus.”

See Dr. Linda Hughes’ answer to this question.

 

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When is a myomectomy better than a Uterine Fibroid Embolization (UFE)?

 

Depending on the size, location, and types of your fibroids, there may be different treatment options that will work best for you. Dr. Linda Hughes, M.D., explains when a myomectomy may be the better choice.

“Fibroids are made out of smooth muscle. The uterus is a smooth muscle organ, and the myometrium of the wall of the uterus is typically where fibroids grow. In a small percentage of women, they can have what are called pedunculated fibroids that grow on a stalk. Typically, the stalk tends to be like a mushroom where it has a broad base and the fibroid is the mushroom cap. That is a safe fibroid for us to embolize, because when you cut the blood flow off, it’s going to shrink and retract into the wall of the uterus.

“In a very small percentage of women, the stalk can be thin like a lollipop. So you have a thin stalk and the top of the lollipop is actually the fibroid. In that situation, an embolization is probably not the most appropriate, because there is the potential for the thin stalk to snap off and for the fibroid to be rolling around in the belly, and can cause peritonitis and pain.

“In this day and age we have MRIs that we do on every woman prior to an embolization to assess the size, number and location of the fibroids. So, there are situations where either we’ll say it’s not appropriate for us to do the embolization, or there are situations where we’ll do the embolization in conjunction with the gynecologist, and laparoscopically they can remove that one thin pedunculated fibroid if that needs to be done.”

See Dr. Suzanne Slonim’s answer to this question.

 

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What is a myomectomy? What are the challenges with a myomectomy?

 

While uterine fibroid embolization is a less invasive procedure performed by an interventional radiologist, a myomectomy is performed by a gynecologist and is slightly more invasive. Dr. Linda Hughes, M.D., details exactly what happens in this procedure.

“A myomectomy is a surgical procedure performed by the gynecologist that involves removing the actual fibroids but leaving the uterus intact. Typically, that is done for future fertility or if a woman wants to get pregnant in the future. Myomectomy used to be a lot more popular, but as embolization has gotten more popular, myomectomy has gotten less popular.

“Whether it’s a laparoscopic myomectomy or an open myomectomy, it still involves general anesthesia, surgical incision, a longer recovery time, a higher incidence of bleeding and blood transfusions because you’re not cutting off or reducing the blood supply, as well as about a third of them recur or grow back.”

See Dr. Suzanne Slonim’s answer to this question.

 

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