Uterine Fibroid Removal Surgery - Procedure, Risks and Preparation
Listed below is the step by step procedure of Uterine Fibroid Removal Surgery:
- What is Uterine Fibroid Removal Surgery?
- Why is uterine fibroid removal surgery required?
- Pre-operative Preparation
- Day Before Surgery
- Methods of Uterine Fibroid Removal Surgery
- Post Surgery
- Risks and Complications
What is Uterine Fibroid Removal Surgery?
Uterine fibroids are benign lumps of muscles and fibrous tissues that grow on the uterine walls. Although the exact cause of fibroids is not confirmed, several risk factors are associated, such as genetics, hormones, processed food, sedentary lifestyle, etc. Usually, for large, multiple, and recurring uterine fibroids, surgery is required to treat the condition completely. Depending upon the severity, the surgeon may perform uterine fibroid removal surgery called a myomectomy. However, uterus removal surgery, called hysterectomy, is advised in cases where the fibroids are recurring and the symptoms keep worsening with time. Based on some factors, the doctor decides whether to remove a part of the uterus (partial hysterectomy) or the entire uterus (total hysterectomy).
Why is Uterine Fibroid Removal Surgery Required?
Uterine fibroids are non-cancerous growths on the inner walls of the uterus. These muscular fibrous protrusions tend to enlarge with time, making symptoms worse. Heavy and painful periods, irregular periods, faster weight gain, pain during sex, discomforts in passing urine, etc., are the common symptoms of uterine fibroids that cannot be left unattended for too long.
Uterine fibroid removal surgery in the following scenarios:
- Multiple fibroids in the uterus
- Fibroids increasing in size
- Recurring uterine fibroids
In such cases, when uterine fibroids are neglected, the female may experience severe physical discomforts and become prone to infertility.
- Based on the assessment of your overall health, the doctor may prescribe some medicines before surgery. The goal is to shrink fibroids for easier surgical removal.
- Before surgery, the doctor also recommends medical tests such as MRIs, blood tests, electrocardiogram (ECG), and pelvic ultrasound to assess the overall health and check for any underlying health issues.
- If you are already taking any medication, let your doctor know as you may need to stop taking them a few weeks before uterine fibroid removal surgery. Maintaining transparency about your medical history is necessary.
- You will need to abstain from alcohol and smoking 4-6 weeks before the surgery until complete recovery. Doctors advise practising abstinence as both alcohol and nicotine increase the chances of cardiovascular complications during the surgery and cause hindrance in the uterine fibroid removal surgery recovery.
Day Before Surgery
Generally, doctors ask the patient to get admitted one day before the uterine fibroid removal surgery. This is helpful for the patient to adjust to the hospital environment and feel comfortable. The patient is advised to have light meals and asked not to consume anything on the night before uterine fibroid removal surgery. It is recommended because once the patient is given anaesthesia, their intestinal walls relax, which may cause its content to get leaked to the oesophagus (food pipe) or anus. Doctors also prescribe antacids and laxatives to prevent any such complications.
Methods of Uterine Fibroid Removal Surgery
- Abdominal Myomectomy: This conventional surgical procedure is also known as open myomectomy. In this approach, the surgeon makes an open surgical incision in the abdomen to gain access to the uterus to remove fibroids. Once the fibroids are removed, the surgeon stitches back the abdominal wall and skin using sutures. Abdominal is usually conducted in the cases of several deeply rooted fibroids.
- Laparoscopic Myomectomy: This is the minimally invasive uterine fibroid removal surgery. In laparoscopic myomectomy, the doctor makes small incisions around the lower abdomen and visualizes the uterus with the help of a laparoscope, which is inserted through any of the incisions. Further, the doctor removes the fibroids using surgical instruments inserted through the other incisions.
- Robotic Myomectomy: The procedure of robotic myomectomy is almost similar to laparoscopic myomectomy. However, in this advanced approach, the doctor controls the surgical instruments from a distance at a console.
- Abdominal Hysterectomy (Conventional Open Surgery): This is the traditional procedure of removing the partial or complete uterus, based on how severe the condition is. It is considered the final treatment option for uterine fibroids as a female becomes infertile with the removal of the uterus (or its parts). Abdominal hysterectomy is complex and usually takes about 6-8 weeks for a patient to recover fully. However, in some cases, the recovery period may prolong due to some complications.
- Laparoscopic Hysterectomy: Laparoscopic surgery to remove fibroids is minimally invasive and offers faster recovery without any significant complication. Nowadays, it is among the most preferred techniques that involve negligible blood loss, minimal scarring and lesser chances of post-surgery complications. In laparoscopic hysterectomy, minor incisions are made in the lower abdomen. Through one of the nicks, the laparoscope is inserted to visualize the internal organs accessing the uterus, whereas, surgical instruments are inserted through the other incisions. Depending upon the severity of uterine fibroids, the surgeon removes the cervix with or without the other parts like fallopian tubes or ovaries.
Different types of Laparoscopic Hysterectomy are:
- Total laparoscopic hysterectomy: The entire uterus is removed in small fragments through surgical incisions or the vagina.
- Laparoscopically Assisted Vaginal Hysterectomy: Uterus is detached from other reproductive parts (fallopian tubes and ovaries), and the pelvic structure and all the organs are removed from the body through the vagina.
- Laparoscopic Supracervical Hysterectomy: In this advanced technique, the surgeon only removes the uterus, leaving the cervix intact.
- Robotic-assisted Laparoscopic Hysterectomy: The method is quite similar to laparoscopic hysterectomy in robotic hysterectomy. However, the only difference is that the surgeon uses control devices to direct surgical instruments for uterus removal in a robotic hysterectomy.
Immediate care in the hospital: The patient becomes conscious as the anaesthesia gradually wears off. Once the patient is fully awake, the surgeon performs a general physical examination to ensure everything is fine and the operated area of the body is clean and dry. Doctors advise not eating anything immediately after the procedure. The patient is also administered intravenous (IV) saline or glucose solution.
- Home care instructions: After getting discharged from the hospital, getting proper rest at home is of utmost importance. Changing the wound dressing at regular intervals and keeping the area dry and airy aids in speedy recovery. Also, a significant emphasis lies in not over-exerting the body and eating light and balanced meals. Though rare, immediate consultation with the doctor is mandatory if any bleeding, sudden increasing pain, or discharge from the wound occurs. The delay in doing so may prolong the recovery and make the phase more uncomfortable.
- Physical Activity: You should not indulge in strenuous physical activities such as high-intensity workouts or sexual intercourse for around 4-6 weeks. You can gradually start to walk a few steps 1-2 days after the surgery as it helps regain physical stamina. Taking doctor recommendations for iron supplements helps in faster recovery and better vitality. Refrain from driving under the effects of sedatives and travel for long hours until complete recovery. Also, lifting heavy weight during the recovery period is a strict no as it can pressure the operated area and give rise to unexpected complications.
Risks and Complications
During the surgery:
Usually, no severe complication arises during the procedure. However, based on the condition’s severity and the patient’s overall well-being, the following complications may occur:
- Allergic response to the anaesthesia
- Heavy blood loss
- Scarring or damage to the surrounding tissues
- Scarring of the urinary tract
Like any other surgery, uterine fibroid removal surgery side effects can occur. In most cases, the patients experience only mild discomforts without any serious risks. However, sometimes, due to a lack of proper care and rest, the following complications may occur:
- Difficulty in bowel movements or passing urine
- Fertility problems
- Pregnancy-related complications
- Scar tissue formation, leading internal surrounding organs to get glued together
If Left Untreated For a Long Time:
When uterine fibroids are neglected for too long, these can get enlarged along with the formation of new ones. As they grow in size and number, the symptoms such as painful irregular periods, weight gain, and mood swings keep worsening. Furthermore, the added pressure exerted by uterine fibroids may result in issues like urinary incontinence, frequent urge to pass urine and infertility.
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