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Surgical Procedures for Uterine Fibroids
Frequently, fibroids can be managed by procedures designed to treat the symptoms uterine fibroids cause. There are many medications that can treat symptoms, but sometimes, surgery is indicated.
Dilation and Curettage (D&C)
If abnormal bleeding is your primary concern, you may undergo a procedure called a dilation and curettage (D&C). The cervix is dilated wide enough to introduce a curved blade that scrapes out the lining of the uterus.
The two main reasons for this procedure are:
- To obtain a sample of endometrial tissue for examination to rule out endometrial cancer
- To reduce the thickness of the endometrium, which may cure the excessive bleeding
Uterine Fibroid Embolization
Uterine fibroid embolization is designed to cut off the blood flow to fibroids and kill them by cutting their lifeline.
During this procedure, a radiologist will thread a catheter into an artery in your groin and guide it into the uterus. The catheter will be threaded with the aid of dye and x-rays . The radiologist will then inject small particles to block the blood supply feeding the fibroids.
Myolysis and Cryohemolysis
Myolysis is a procedure that shrinks the fibroids, using a directed heat source. Several devices can be used that have high frequency electrical current or lasers that cauterize (burn) the blood supply to the fibroids. The devices are usually inserted through very small incisions and guided by a laparoscope. As an alternative, cryohemolysis uses liquid nitrogen to freeze the fibroids.
The fibroids remain in place and are not surgically removed. Without a blood supply, the fibroids shrink. Myolysis and cryohemolysis are done on fibroids of certain sizes near the surface of the uterus.
Focused Ultrasound Surgery
In this procedure, you will be inside an MRI scan machine, which will allow your uterus and the rest of the abdominal area to be viewed. Focused sound waves will be used to destroy the fibroids, while leaving your uterus intact.
Myomectomy is the surgical removal of fibroids without removing the uterus. Unlike a hysterectomy, a myomectomy can preserve fertility. There are a variety of ways a myomectomy can be performed depending on where the fibroids are located and how large they are. Examples are:
- Laparotomy (abdominal myomectomy)—This technique uses a surgical entry into the abdomen. Fibroids on the surface and in the body of the uterus can be removed.
- Laparoscopic myomectomy—Some fibroids are small and accessible enough to be removed through small incisions near the navel using a laparoscope (a thin telescope with a light).
- Laparoscopic myomectomy with mini-laparotomy—Larger fibroids on the surface of the uterus may be removed through a slightly larger incision using a combination of standard surgical techniques and a laparoscope.
- Laparoscopic-assisted vaginal myomectomy (LAVM)—Some fibroids can be reached through the vagina, using a similar combination of standard surgery and a laparoscope.
- Hysteroscopic myomectomy—Fibroids located on the inside of the uterus may be reached using a different but similar instrument, a hysteroscope, which is inserted through the vagina and cervix.
- Endometrial ablation —This procedure applies heat to the uterine lining, thus destroying it and preventing further abnormal bleeding. It is only effective against fibroids that are within the uterine lining.
A hysterectomy is removal of the uterus. There are different types of this procedure, such as:
A supracervical hysterectomy is surgery to remove the uterus only. This is not done as often because the cervix can still cause problems. However, a woman may choose this option if she wants to keep her cervix or if the removal of the cervix may make the surgery more difficult.
A total hysterectomy is done either through the abdomen or, if the uterus is small enough, through the vagina. A vaginal approach may be combined with a repair of weakened and stretched tissues in the vaginal walls.
Pregnancy is impossible after a hysterectomy.
When to Contact Your Doctor
Contact your doctor if any of the following occur after your procedure:
- Fever and other signs of infection
- Pain that is not treated by pain relievers
- Inability to urinate
- Abdominal swelling
Fibroids. Healthy Women website. Available at: http://www.healthywomen.org/condition/fibroids. Updated August 9, 2011. Accessed January 7, 2014.
Uterine fibroids. Focused Ultrasound Foundation website. Available at: http://www.fusfoundation.org/Uterine-Fibroids/uterine-fibroids. Accessed January 7, 2014.
Uterine leiomyoma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated November 7, 2013. Accessed January 7, 2014.
- Reviewer: Andrea Chisholm, MD
- Review Date: 12/2014
- Update Date: 12/20/2014