We are one of leading manufactor in scaffolding including ringlock system, cuplock system, scaffolding clamp, props, construction hoist. Myomectomy means the surgical removal of just the fibroid, with reconstruction and repair of the uterus. Studies show there may actually be less risk of complications during myomectomy than during hysterectomy. After inspecting the uterus to determine the number and position of the fibroids, the uterus is injected with pitressin, a solution that limits bleeding during the surgery.
Another new advance in surgery has been the use of special substances, called adhesion barriers, which help prevent the formation of scar tissue after surgery. The adhesion barrier Seprafilm is teased out of its paper protection onto the incision in the uterus.
The first few days after surgery are the hardest, and research is always being done in an effort to ease postoperative discomfort. The catheter has small holes that allow the local anesthetic to be sprinkled under the incision area. A cell saver is a surgical machine that suctions blood from the surgery site, washes it with sterile salt water, filters it and then gives the patient their own blood through her IV. In a study of 91 women with fibroids larger than 16 weeks (ranging from 16 to 36 weeks), no one needed to have the surgery changed to a hysterectomy. Donated blood, even if you donate your own blood, decreases in quality every day it sits in the blood bank. Studies show that ill patients in an ICU who were transfused had more problems than patients with similar levels of anemia who did not get transfused. If your blood count is very low (hemoglobin levels below 9), I usually use Procrit to stimulate red blood cell production for about 3 weeks before surgery. A number of surgical techniques can be used to reduce the risk of blood loss during surgery. An additional strategy is the use of the cell saver, which allows me to replace blood loss, if necessary, immediately during surgery with the patient’s own fresh blood before the blood has a chance to deteriorate. And lastly, the current recommendation is to not get a blood transfusion unless it is really necessary: if you are very dizzy or weak when you stand up, or if your hemoglobin is below 7 (normal is 12). Some studies suggest that there may be less risk of intraoperative injury with abdominal myomectomy compared to abdominal hysterectomy. Experienced surgeons can safely perform a myomectomy in carefully chosen women during a Cesarean section. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 and am an internationally recognized expert in fibroid surgery and research. Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. Powered by Google FeedBurner : Receive free updates right to your inbox every time new content is added to this website. There are now a number of techniques used to perform myomectomy: through an abdominal incision, vaginal incision, with a laparoscope, or with a hysteroscope.
One study of women who had myomectomies and women who had hysterectomies for fibroids of the same sizes (about 4 months pregnancy size) found surgery took slightly longer in the myomectomy group (200 v.
Then the covering of the uterus overlying the fibroid is cut (illustration 1), and the fibroids are separated and removed from the normal uterine muscle (illustration 2).
For abdominal myomectomy, small sheets of thin transparent material can be wrapped around the raw areas from surgery and the material prevents nearby tissue such as the intestines from sticking to the surgery sites. The Seprafilm will dissolve within 2 weeks, after the uterine incision has started to heal.


With this method, a small bedside pump drips pain medication into your IV at a very controlled, slow, and steady rate. Some doctors and some managed-care organizations have policies stating that an abdominal myomectomy cannot be attempted if the uterus is bigger than a certain size (usually a three-month pregnancy size). Making the incisions down to the area between the fibroid and normal muscle, where there are very few blood vessels, will reduce bleeding. Therefore, there is less need to give your own blood before surgery and less need for a blood transfusion, avoiding the risk of infection or transfusion reaction.
Complications were very rare and, by using a cell-saver, very few women (7) required a blood transfusion. The blood cells become more fragile and when they are transfused they clog up capillaries and block blood flow and oxygen delivery to the body’s cells.
Although serious problems are less of a risk for young, healthy women who are having myomectomies (compared to 80 year-olds in an ICU!), the best strategy is for you to get your blood count up before surgery and the use of a cell-saver during surgery. This medication is exactly like the protein made by the kidney that tells the bone marrow to make more red blood cells. I use Pitressin, a medication that makes blood vessels constrict and which has been shown to effectively decrease blood loss during myomectomy. In addition, with the cell-saver, since you get your own blood there is no risk of HIV, hepatitis or mismatched blood.
Since the transfused blood doesn’t work very well, it is better and safer to take lots of iron and let your body to build up your own blood count slowly during the recovery period. One study of women having surgery for fibroids showed that operating times were slightly longer in the myomectomy group, but blood loss was slightly more in women who had a hysterectomy. I always make a bikini incision (medical name is Pfannensteil incision after the doctor who developed it). One study of twenty-five women who had myomectomies performed for fibroids between 2 and 10 cm, showed that although five women needed a blood transfusion, no one needed to have a hysterectomy.
In that fibroids push away normal uterine muscle as they grow (and do not destroy it), the normal uterine muscle can be sewn back together (illustration 3). After a few weeks, the material dissolves, leaving the newly healed surgery sites fairly free of adhesions. With this steady low level of medication, you should not develop significant pain and the total amount of medication necessary per day is much smaller than with shots.
Although I rarely need to use the cell-saver, I have it available outside the room for every myomectomy surgery. Many gynecologic surgeons don’t have training in these techniques and so don’t offer them.  Dr. It is important to also take high doses of iron to provide your body with the building blocks to make red blood cells. It is important to find the exact area where the fibroid starts and the normal uterine muscle ends – this is the area where the fewest blood vessels are found and where the least amount of bleeding occurs when removing the fibroid. The risks of severe complications such as severe bleeding, fever, life-threatening problems or need for readmission to the hospital were the same for both groups of women. The incision is about 1 inch above the pubic bone and 4-6 inches long, depending on the size of the fibroids.
Another study found that less than 1% of women needed a transfusion and none required hysterectomy. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. The risks of bleeding, fever, life-threatening complications, need for another surgical procedure or re-admission to the hospital were not different.


This procedure takes about one to two hours, depending on the number, sizes and positions of the fibroids. While the barriers are not perfect, they have been shown to help reduce the formation of adhesions. The tubes are connected to a tennis ball sized device that slowly and evenly pushes local anesthetic contained in the ball into the incision – exactly where you need it. However, gynecologists who are skilled and experienced at myomectomy surgery can perform an abdominal myomectomy on just about any size uterus (see photo gallery below).
Parker is considered one of the best fibroid surgeons for abdominal or laparoscopic myomectomy in the United States and abroad and is able to perform myomectomy surgery with minimal blood loss, a short time under anesthesia for the patient, and with consistently good outcomes. After each fibroid is removed, it is important to suture closed the hole in the normal uterine muscle so that bleeding is stopped immediately. However, 13% of women in the abdominal hysterectomy group had a complication, including 1 bladder injury, 1 ureteral injury, 3 bowel injuries, 8 women who had nausea, vomiting and slow return of bowel movements, and 6 women with pelvic infections. The tissue underneath the skin called the fascia is then cut to allow access to the abdominal cavity.
The authors concluded that, in experienced hands, myomectomy may be safely performed in some women during Cesarean section. However, women are often told that myomectomy is not appropriate for them because hysterectomy is safer, is associated with less bleeding or that uterine muscle cancer (sarcoma) may be present.
The authors of the study concluded that there was no difference in complications and with an experienced surgeon myomectomy is a safe alternative to hysterectomy.
Following surgery, a woman having an abdominal myomectomy may need to stay in the hospital for two to three days. For women who have very numerous, large fibroids, I set the cell-saver up right at the beginning of the surgery. He is also an internationally recognized expert in fibroid surgery and research.  Ask your doctor and get some clarification on their experience with myomectomy surgery.
There is no magic number, but it is safer to have the hemoglobin 10 or higher before surgery. In contrast, complications occurred in only 5% of the abdominal myomectomy patients, including 1 bladder injury, 2 women who needed another operation for a bowel obstruction and 6 women who had nausea, vomiting and slow return of bowel movements. I do not cut the muscles, but stretch them apart (they have a natural separation) in order to get to the uterus and fibroids. This device greatly reduces the need for injected pain medication which travels throughout the entire body and brain and causes the grogginess that often accompanies narcotics.
In some women, very heavy menstrual bleeding does not allow us to get the blood counts up even with Procrit and Vitamin C (very rare), but this usually works well. The authors concluded that myomectomy should be considered a safe alternative to hysterectomy. A medication can be injected into the uterus that causes the blood vessels in the muscle to constrict, and less blood will seep out of the incisions in the uterine wall.
Or the doctor can place an elastic tourniquet around the lower portion of the uterus to decrease the blood flow to the uterus.




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