December 13, 2017

Fibroids

Fibroids

Myomectomy for fibroidsFibroids are benign muscle growths in the muscle of the uterus. The uterus is made up of two parts: the lining of the uterus (endometrium) and the muscle of the uterus. The lining of the uterus is the part that is built up in response to the hormone estrogen from the ovaries. The lining of the uterus is then shed as a period in response to the hormone progesterone from the ovaries.

The muscle of the uterus is responsible for the contractions during labor. It is also responsible for stopping the uterus from bleeding during a period. Progesterone gives the signal for the lining of the uterus to shed, it sheds, and the blood vessels that were feeding the lining of the uterus are now open to bleed. The uterine muscle that surrounds these bloods vessels needs to contract or squeeze down to stop the bleeding.

Fibroids (hard muscle tumors) that are next to the lining of the uterus get in the way of the muscle being able to squeeze the blood vessels closed. When this happens the uterus bleeds heavily for a longer time because it is unable to stop itself from bleeding. This is how fibroids lead to long heavy periods.

Fibroids can also cause painful periods. Fibroids are made of much more dense muscle than the normal wall of the uterus. This dense muscle does not contract the way normal uterine muscle does. Since the normal muscle has to contract around the hard fibroid tumors, the normal muscle has to contract harder, causing more pain. Also since the bleeding lasts longer, the contractions of the muscle have to occur for more days and the pain lasts longer.

Fibroids come in all sizes and locations. They can range from the size of a pin head to the size of a basketball. Usually they are discovered when they are the size of a golf ball to the size of an orange. Larger fibroids cause pressure in the pelvis no matter where in the uterus they are located. The larger the fibroid, the more pressure on the bladder, rectum, abdomen, and the pelvis in general.
The location of the fibroid is important in bleeding. Even a very small fibroid can cause very heavy bleeding if it is located near the lining of the uterus. The closer the fibroid is to the lining of the uterus, the heavier the bleeding.

Myomectomy

Myomectomy is the removal of fibroid tumors from the uterus, leaving the uterus in place. This surgery is mostly done for women who want to preserve the ability to get pregnant. It is also done for women who want to keep their uterus and avoid a hysterectomy.

Fibroids can be removed from the uterus using three different types of surgery: (1) Laparoscopic myomectomy, (2) open myomectomy, (3) hysteroscopic myomectomy.

(1) Laparoscopic myomectomy is the removal of fibroids through 4 abdominal incisions that are ¼ to ½ inch in diameter. A camera is placed through one of these incisions. The image from the camera is projected onto a TV screen that allows the surgeon to see the entire abdomen. Instruments are placed through the other incisions. The surgeon’s hands control these instruments to remove the fibroids from the uterus. The fibroids are then removed from the abdomen using a tool called the morcelator. The morcelator is a tube with a rotating blade at the end. The morcelator allows the surgeon to remove the fibroid piece by piece until it is completely outside the abdomen. The muscle of the uterus is then stitched together to make it strong enough to hold a pregnancy.

Sometimes laparoscopic myomectomy is done with the aid of the DaVinci Robot.The DaVinci Robot is the cutting edge of laparoscopic technology.

Dr. Maikis has removed hundreds of fibroids laparoscopically, and with the aid of the DaVinci robot. Myomectomy is one of the surgeries that has advanced the most as a result of the robotic technology. The robot allows for a much better closure of the uterus after the fibroids are removed. This makes the uterine muscle much stronger, and better able to hold a pregnancy longer. Dr. Maikis has many patients who have had successful pregnancies after myomectomy.

Laparoscopic myomectomy leads to a much shorter recovery time, shorter stay in the hospital, and much less pain than the traditional open myomectomy. This is because the incisions are much smaller. Laparoscpic myomectomy is usually a same day surgery with a one to two week recovery off from work and other activities.

(2) Open myomectomy is the way all fibroids used to be removed from the uterus. This is done through an incision in the lower part of the abdomen, much like a cesarean section incision. The size of the incision depends on the size of the fibroid. Open myomectomy is used if the fibroid is too large to be removed by the laparoscope or the fibroid is taking up the entire wall of the uterus. A fibroid that takes up the entire wall of the uterus, once removed, leads to such a large gap in the muscle of the uterus that it is difficult to close properly. If the wall of the uterus is not closed properly, it could lead to problems with the strength of the wall during pregnancy. Open myomectomy is also used if there are more than 5-10 fibroids in the uterus. Open myomectomy requires a 1-2 night hospital stay, and 4-6 week recovery time.

(3) Hysteroscopic myomectomy means removal of the fibroid through the cervix. A camera called a hysteroscope is inserted through the vagina into the cervix to visualized the inside lining of the uterus. If a fibroid is in or next to the lining of the uterus, it most likely causes very heavy bleeding. Sometimes a single fibroid of only ½ inch in diameter can cause very heavy bleeding if located in the lining of the uterus. The hysteroscope has an electric wire loop attached to the end that allows the fibroid to be cut into pieces and removed through the cervix. Since hysteroscopic surgery is done through the cervix, no abdominal incisions are necessary. The benefits of this type of fibroid removal are same day surgery and only two to three day recovery time.