Critical Points in Myoma Surgery
Myomas, also known as fibroids, are the most common tumors of the uterus. Approximately half of women of reproductive age are diagnosed with a myoma at some point in their lives. More than 99% of myomas are benign; very rarely, a mass thought to be a myoma may contain malignant cells.
What Symptoms Can Myomas Cause?
Symptoms vary according to the location and size of the myoma. Small myomas within the uterine wall or growing toward the outside of the uterus may cause no symptoms. Myomas growing into the uterine cavity can lead to irregular bleeding and problems related to fertility and pregnancy. Myomas located at the uterine corners where the fallopian tubes enter the uterus may be associated with infertility. Larger myomas can cause pelvic pain, pain during intercourse, frequent urination, constipation or difficulty passing stool, reduced exercise capacity, and fatigue.
What Should Be Considered in Myoma Treatment?
Not every myoma requires treatment. Small myomas that do not cause symptoms can be monitored. Treatment may be needed for large or symptomatic myomas. The first decision, therefore, is whether treatment is actually necessary.
Medication does not completely eliminate myomas; definitive treatment is surgery. Surgical options include removal of the myomas while preserving the uterus (myomectomy) or removal of the uterus (hysterectomy). The decision should be individualized by considering factors such as age, reproductive plans, and psychological well-being.
Critical Points When Preserving the Uterus and Fertility
- To reduce the risk of recurrence, the aim should be to remove all myomas, including millimetric ones.
- Care should be taken to avoid damage to the uterine lining, preserve the blood supply of the uterus, and repair the uterus properly if the cavity is entered. This helps minimize adhesions and possible effects on fertility.
- When operating near the uterine corners where the tubes enter the uterus, suitable incision and suturing techniques should be used to preserve tubal patency.
Should Myomas Be Removed with Open or Minimally Invasive Surgery?
Myomas can be removed by open or minimally invasive surgery. In minimally invasive surgery, morcellation may be needed to remove the myoma from the abdomen. If a mass presumed to be a myoma contains unrecognized malignant cells, this procedure has been reported to be associated with spread within the abdomen. Even benign myoma cells may potentially spread and form new myoma deposits elsewhere. These issues should therefore be discussed in detail before minimally invasive surgery is planned.
These dissemination risks have not been reported for open myomectomy. When preservation of the uterus is the goal, open surgery may offer an advantage in this regard. For patients planning hysterectomy, the method is selected according to the patient and the condition of the uterus. Recovery after open surgery is longer, whereas patients often return to daily activities within one or two days after minimally invasive surgery; recovery after open surgery may take several days longer.
Conclusion
The key step in myoma management is determining correctly whether observation or treatment is needed. Definitive treatment is myomectomy or hysterectomy. The benefits and risks of open and minimally invasive surgery should be considered together with the patient. In myomectomy procedures that preserve the uterus, surgical details that protect fertility are especially important.
Possible Risks of Surgery
With modern surgical approaches, the risk of complications is low. In addition to anesthesia-related risks, bleeding, infection, injury to nearby organs, and blood-clot formation may occur. These risks can be minimized as much as possible in appropriate hospital conditions and with experienced teams.