1. Preoperative Evaluation:
- A thorough medical history and physical examination are performed.
- Imaging tests, such as ultrasound or MRI, are used to identify and locate the fibroids.
- Blood tests may be done to assess overall health and clotting function.
2. Surgical Technique:
- The choice of surgical approach depends on the size, location, and number of fibroids. Myomectomy can be performed through:
- Abdominal Myomectomy: A surgical incision is made in the lower abdomen to access the uterus. Fibroids are removed individually, and the uterine wall is repaired.
- Laparoscopic Myomectomy: This minimally invasive technique uses a laparoscope and small incisions to access the uterus. Instruments are inserted through these incisions to remove fibroids.
- Hysteroscopic Myomectomy: This technique is used to remove fibroids located inside the uterine cavity. A hysteroscope is inserted through the cervix to view and remove the fibroids.
3. Fibroid Removal:
- During the procedure, the surgeon carefully separates the fibroids from the surrounding uterine tissue.
- The fibroids are removed, and the uterine wall is sutured closed.
- In some cases, additional techniques may be used to control bleeding or minimize the risk of complications.
4. Postoperative Care:
- After the procedure, patients may experience some discomfort, swelling, and vaginal bleeding.
- Pain relievers and antibiotics may be prescribed to manage these symptoms.
- Patients typically stay in the hospital for a few days after surgery and may require several weeks of recovery before returning to normal activities.
Instruments for Myomectomy
The specific instruments used for myomectomy may vary depending on the surgical technique and the preference of the surgeon. Here are some commonly used instruments:
- Scalpel or Electrosurgical Cautery: These instruments are used to make incisions and control bleeding.
- Retractors: These instruments are used to hold tissue apart and provide visualization during the surgery.
- Scissors and Graspers: These instruments are used to manipulate tissue and remove fibroids.
- Sutures and Staplers: These are used to close the incisions and repair the uterine wall.
- Laparoscope and Hysteroscope: These instruments are used for minimally invasive procedures, allowing the surgeon to visualize and access the uterus through small incisions.
- Ultrasound: Ultrasound imaging may be used during the surgery to guide the placement of instruments and ensure accurate fibroid removal.
The selection and use of these instruments are essential for performing a successful and safe myomectomy.