Surgical Treatment Options continued...
Hysterectomy: Surgery to remove the entire uterus and all uterine fibroids. Hysterectomy cures uterine fibroids and prevents them from ever returning. Women with symptoms from uterine fibroids who don’t want a future pregnancy often undergo hysterectomy.
Surgeons perform myomectomy and hysterectomy through different techniques. These can determine time in the hospital, healing time, and scarring.
- Open abdominal surgery: A surgeon makes a 5-inch to 7-inch incision either up and down or side to side across the belly. The fibroids (and/or the uterus) are removed through this incision.
- Vaginal approach: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar on the abdominal wall.
- Laparoscopy: Several small cuts are made in the belly, and a lighted camera and surgical tools are inserted through these incisions. In a single site laparoscopic procedure, just one small cut is made through the belly button. The surgeon operates from outside the body and removes the fibroids or fibroids and uterus through these small incisions or through a vaginal incision, viewing the operation on a video screen.
- Robot-assisted laparoscopy: This procedure is similar to laparoscopy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the surgery on a three-dimensional screen.
- A less invasive type of myomectomy uses a hysteroscope -- the long, thin lighted tube mentioned above -- to enter the uterus through the vagina and cervix and remove submucosal fibroids. Fibroids can then be removed by a tool inserted through the hysteroscope.
The vaginal approach, laparoscopy, and robot-assisted laparoscopy are minimally invasive procedures or MIPs. MIPs offer certain benefits over the more traditional open surgery approach. In general, a MIP allows for faster recovery, shorter hospital stays, and less pain and scarring than does an open abdominal surgery.
One recent study of hysterectomies showed a higher rate of postoperative infection in patients with open abdominal surgery. The average length of time in the hospital for patients undergoing a MIP ranged from 1.6 days to 2.2 days, compared to 3.7 days for abdominal hysterectomies. With a MIP, women are generally able to resume their normal activity within a much shorter period of time than they are after an open surgery. And the costs associated with a MIP are considerably lower than the costs associated with open surgery. (This depends on the instruments used and the time spent in the operating room. Robotic procedures are much more expensive.) There is also less risk of incisional hernias with a MIP.
Not every woman is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not a MIP is advisable. You should talk with your doctor about whether you might be a candidate for a MIP.