Myoma surgery (myomectomy)

Subserosal and intramural myomas are operated on laparoscopically. Miomas that cause symptoms are operated on.

We perform classic laparotomy with a special focus on mini-laparotomy, which is characterized by a discreet, low incision of 4-6 cm that provides faster recovery and minimal scarring.

When fibroids are very large or located on the posterior wall, a longitudinal incision is used for optimal access and safety. This technique is ideal for the effective removal of subserous and intramural myomas, especially when they are larger than 10 cm or there are more of them.

• Upon arrival at the Clinic, the patient is placed in the patient room where she is prepared for the surgery. A cannula is inserted into the vein so that the patient can receive the necessary drugs.
• The vagina is treated with a saline solution or an antiseptic agent containing iodine or chlorine.
• After receiving anesthesia, the hysteroscope is "inserted" into the cervix. Considering that the hysteroscope is 5-9 mm in diameter, it is most often necessary to perform dilatation, that is, to widen the cervix canal with instruments so that the hysteroscope can reach the uterine cavity.
• First, the cervical canal is examined, and then the uterine cavity itself, where the myoma is identified.
• Resectoscopic removal of myomas is done by inserting a looped instrument into the hysteroscope connected to a bipolar energy generator. With the loop, the myoma is removed part by part until it reaches the level of the uterine wall, that is, the myometrium.
• When resectoscopy is combined with a mechanical instrument, the part located in the wall of the uterus (intramural part) is removed with the help of a mechanical hook and then the operation continues with the resectoscope. "
• “Shaver" is an instrument with rotating blades that remove the myoma and then parts of the myoma are aspirated from the uterine cavity. The fluid that is always in the uterus is saline solution.

Sometimes it is necessary to repeat the hysteroscopy if the myoma is larger than 3 cm.

The tissue that is removed is sent to a pathologist for analysis.

The surgery lasts 15-45 minutes.

• The patient moves to the patient room where she stays for up to 2 hours after the fibroid surgery.
• First she gets water and then a light meal.
• Antibiotics are usually prescribed after hysteroscopy.
• Pain in the form of cramps or menstrual pain is treated with painkillers, most often paracetamol, ibuprofen and diclofenac.
• Sometimes there is a feeling of nausea and a feeling of fatigue.
• The patient is not advised to drive a car on the day of surgery.
• Vaginal bleeding usually stops 2-3 days after surgery.
• The patient can return to normal activities the day after the surgery.
• The use of vaginal tampons, bathing in the bathtub, swimming, as well as sexual intercourse is not recommended as long as the bleeding lasts. 
• The next period will come at the expected time.

The patient will be informed about the result of the histopathological findings 7-10 days after the surgery.

• A catheter is inserted into the patient's bladder.
• If it is determined on the ultrasound examination that the myoma is very close to or touching the uterine cavity, a catheter is inserted into the uterus into which a sterile blue liquid is injected for easier orientation during the surgery.
• After preparing the operating field and receiving general anesthesia, a small incision is made on the navel and carbon dioxide is injected into the abdominal cavity with a special needle to "separate" the organs from the front abdominal wall.
• An instrument with a camera is inserted into the abdominal cavity through the same incision, and then two or three small 5 mm incisions are made to insert additional instruments.
• Then the myoma is separated from the uterine wall with adequate stopping of bleeding.
• The wall of the uterus is sutured with sutures that dissolve spontaneously a certain time.
• Myomas are removed from the abdominal cavity by widening an incision in the skin or using a special instrument with rotating blades that itself pulls out the myoma itself in small pieces.
• Myomas can be removed laparoscopically using radiofrequency energy, which causes the myomas to die.
• The tissue that is removed is sent for histo-pathological examination.
• Instruments are removed from the abdomen and carbon dioxide is "blown" out of the abdominal cavity.
• The skin incisions are sutured with a suture that does not need to be removed. A protective patch is placed on the incisions and removed after 3-4 days.

• The patient returns to the patient room and receives medication for pain and nausea.
• 3-4 hours after the surgery, the patient starts to drink liquid, and then she is given light food.
• The catheter from the urinary bladder is removed a few hours after the surgery and the catheter from the uterine cavity immediately after the surgery.
• It is desirable that the patient gets out of bed with the help of the staff 2-3 hours after the surgery and can go to the toilet on her own.
• Sometimes a blood transfusion is needed.
• The patient can take a shower on the same day with the help of the staff and is usually discharged from the hospital the day after the surgery.
• It is recommended to avoid work for up to 7-10 days, possibly longer if the patient is not feeling well.
• The protective patches are removed after 3-4 days, while the suture threads do not need to be removed.
• If there is scanty bleeding or secretion from the incisions, it is recommended to wash it exclusively with saline solution.
• In case of temperature, pain or conditions that deviate from normal, the patient contacts the Clinic or the Hospital.
• The patient is informed about the result of the histopathological analysis 7-10 days after the surgery.
• Check-up is usually 3-4 weeks after surgery.
• The patient returns to her usual activities 7-10 days after the surgery.
• She can start training 10-14 days and have sexual intercourse 3-4 weeks after the surgery.

• A catheter is inserted into the patient's bladder.
• After preparing the operative field and obtaining general anesthesia, a low transverse incision is made 2-3 cm above the pubic bone in a length of about 4-6 cm, but it can be extended if necessary. If the patient has an incision from a previous surgery, the abdominal cavity is opened according to the old incision.
• In the case of large myomas, a longitudinal incision is sometimes made from the pubic bone to the navel.
• The myoma is separated from the surrounding healthy tissue.
• After removal of myoma, with adequate control of bleeding, the wall of the uterus is sutured.
• The entire uterus is carefully examined to identify small myomas. 
• Sometimes a drain is placed in the abdominal cavity, which is removed after 24 hours at the latest.
• The abdominal wall is sutured in layers. 
• The skin is stitched with absorbable sutures and a protective patch is placed on the wound.

The preparation, that is, the tissue removed from the organism, is sent for histo-pathological examination

• The patient returns to the patient room and receives medication for pain and nausea.
• 3-4 hours after the surgery, the patient starts to drink liquid, and then she gets light food.
• The catheter from the urinary bladder is removed a few hours after the surgery and the catheter from the uterine cavity immediately after the surgery.
• It is desirable that the patient gets out of bed with the help of the staff 2-3 hours after the surgery and can go to the toilet on her own.
• Sometimes a blood transfusion is needed.
• The patient can take a shower on the same day or the day after the surgery with the help of the staff and is usually discharged from the hospital a day or two after the surgery.
• It is advised to avoid the work for up to 3-4 weeks, possibly longer if the patient is not feeling well.
• The protective patches are removed after 5-6 days, while the absorbable sutures do not need to be removed.
• If there is scanty bleeding or secretion from the incision, it is recommended to wash it exclusively with saline solution.
• In case of temperature, pain or conditions that deviate from normal, the patient contacts the Clinic or the Hospital.
• The patient is informed about the result of the histopathological analysis. Check-up is usually 3-4 weeks after surgery.

The patient returns to her usual activities 3-4 weeks after the surgery. She can start training and having sexual intercourse 3-4 weeks after the surgery, depending on how he subjectively feels.

• A 30-year-old female patient with 15 intramural and subserous fibroids from two to eight centimeters.
• Regular, heavy menstruation.
• A mini-laparotomy was performed and all myomas were removed.
• The surgery went smoothly and the patient was discharged home on the second day after the surgery.

At the check-up six months after the surgery, there were no myomas. Menstruation has returned to normal, but she is still not planning a pregnancy.

• 35-year-old female patient. One cesarean delivery.
• The patient had a 10 cm subserous myoma during pregnancy. Three years after delivery, the myoma was 20 x 20 cm in size and the enlarged abdomen was clearly visible.
• The patient became pregnant spontaneously and an early vital pregnancy was confirmed by ultrasound examination.
• Considering the size of the myoma, it was estimated that the risk of pregnancy complications would be high.
• Termination of pregnancy was performed and then myoma was removed by classic surgery where a low transverse incision was used after caesarean section with a length of 10 cm.
• The patient received a postoperative blood transfusion and was discharged from the hospital on the fourth postoperative day.
• 3 months after surgery, patient achieved spontaneous pregnancy. Pregnancy was uneventful and she delivered healthy baby by cesarean section.