Advanced Women's Health Institute

Fibroids that are too large for hysteroscopic myomectomy can be removed without the need for hysterectomy. Surgical alternatives to hysterectomy for fibroids include: Open abdominal myomectomy: Through a 4-8 inch abdominal incision, fibroids are removed and the uterus is closed with suture. Women can successfully get pregnant after myomectomy. The procedure has been described in the medical literature for over 100 years. Myomectomy is safe when performed by an appropriately trained physician. Return to work is usually 6 weeks, though complete recovery can take longer. image_9Sr3l2y.jpeg Laparoscopic myomectomy: A pencil-sized (5mm) scope placed through the base of your belly button sends a video image to the monitoring screen while the myomectomy is completed using small, minimally-invasive instruments. This form of myomectomy is outpatient instead of 2-4 days in hospital. We have reported return to work is possible in 10 days for our average patient, not 6 weeks as in a fully-open surgery. The average woman who has laparoscopic myomectomy states she feels fully recovered in 3 weeks. image_ilbpztA.jpeg Laparoscopic myomectomy with endometrial ablation: For the woman who would prefer not to undergo a hysterectomy, but would like to terminate menstrual flow, the uterine lining can be removed at the same time as laparoscopic myomectomy. Uterine artery embolization (UAE): First described in the mid 1990’s, a catheter is inserted into the femoral artery at the top of your leg and guided to the uterine arteries with a live x-ray. Polyvinyl chloride particles will be infused until blood flow no longer can be detected, causing any fibroids to shrink. The majority of women report significant pain, like childbirth for 12-24 hours afterward. One study concluded women who had laparoscopic myomectomy were more satisfied with their outcome than those with UAE. MRI-guided high intensity focused ultrasound: Although approved by the FDA, this procedure cannot treat more than 1-2 fibroids at a time in a 2-3 hour procedure. This is costly and typically is not covered by insurance. The patient with the larger uterus and multiple fibroids would require 2 or more procedures. Uterine artery occlusion: This is described as a laparoscopic procedure to accomplish the same end result as UAE. Myolysis: This was described around 1990 as a laparoscopic procedure to shrink fibroids. It was the first laparoscopic alternative to hysterectomy. To shrink the fibroid, either a laser fiber or a bipolar cautery needle was inserted many times into different locations throughout the tumor. The fibroid gets smaller over the next several weeks. It became less attractive to patients once laparoscopic myomectomy became possible.. Laparoscopic radio frequency ablation: This is a new laparoscopic procedure to accomplish the same end result as myolysis, It appears more effective than myolysis because only one insertion is made. More studies are needed to understand its benefit. It may be difficult to get covered by insurance since it is new. It is an alternative to hysterectomy if laparoscopic myomectomy is not an available option. SONATA: SONATA is a non-laparoscopy radio frequency ablation procedure. No incisions are required.. An ultrasound probe is placed inside the uterus to visualize the fibroids. Under ultrasound guidance a needle is inserted into a fibroid. The ablation is performed and the fibroid shrinks in size over several weeks. It is difficult to treat larger fibroids with SONATA. Also, fibroids that protrude out of the uterus cannot be treated. In some cases SONATA would be combined with laparoscopic and/or hysteroscopic myomectomy. More studies are needed to understand its benefit. It may be difficult to get covered by insurance since it is new. A complete and thorough evaluation is important to the success of any surgery, and every patient is an individual. Dr. Moore and the team will work closely with you to determine your needs and goals in order to help you choose the right procedure.