Myomectomy Surgeries: When, How, and Which Methods Are Used?

Fibroids are benign tumors that develop in the uterus and are quite common in women. Although fibroids often do not cause symptoms, in some cases, they can lead to issues such as heavy bleeding, pain, or infertility. When such symptoms occur, surgical intervention may be necessary.

What Is Myomectomy?

Myomectomy is the surgical removal of fibroids from the uterus. It is a fertility-preserving procedure, especially for women who wish to maintain their ability to have children. Depending on the size, number, and location of the fibroids, open surgery (laparotomy), laparoscopic, or robotic surgical methods can be used.

What Is Laparoscopic Myomectomy?

Laparoscopic myomectomy is a minimally invasive procedure that removes fibroids without making large incisions. Small incisions are made in the abdomen, through which surgical instruments and a camera are inserted to perform the surgery. The advantages of this method include:

• Less pain,

• Shorter hospital stay,

• Faster recovery,

• Smaller surgical scars.

Laparoscopic myomectomy can be performed even in cases where there are large or multiple fibroids. However, the surgeon’s experience and the techniques used are critical for a successful surgery and to minimize the risk of complications.

What Is Morcellation, and Why Should a Morcellation Bag Be Used?

Morcellation is the process of breaking large fibroids into smaller pieces for removal through small abdominal incisions during laparoscopic surgery. While morcellation can be necessary for removing large fibroids, it carries certain risks.

In 2014, the U.S. Food and Drug Administration (FDA) raised concerns about the potential spread of undetected cancer cells during morcellation. Specifically, if the fibroids are a rare form of uterine sarcoma (malignant tumor), morcellation may spread cancerous cells within the abdomen. To minimize this risk, the use of a morcellation bag (contained morcellation) is recommended.

Morcellation Bag (Contained Morcellation)

A morcellation bag is a closed system that allows fibroids to be safely removed. Before morcellation, the fibroids are placed inside a bag, preventing the spread of tissue into the surrounding areas or abdomen. Contained morcellation significantly reduces the risk of spreading cancerous cells in cases where a malignant tumor may unknowingly be morcellated.

Advantages of the Morcellation Bag:

• Reduces the risk of abdominal contamination,

• Minimizes the risk of fibroid tissue spread,

• Prevents the dissemination of potentially malignant cells in the abdomen.

Who Is a Suitable Candidate for Laparoscopic Myomectomy?

Laparoscopic myomectomy may be suitable depending on the location, size, and overall health of the patient. It is generally preferred in the following cases:

• When fibroids are small to medium in size,

• When fibroids do not cause significant structural deformities in the uterus,

• When the patient wishes to preserve fertility.

However, for large fibroids or deeply located fibroids, open surgery may be necessary. Therefore, the most appropriate treatment method should be individually evaluated for each patient.