Gynecological surgery to remove the entire uterus is the most common and complete fibroid treatment as it prevents any risk of recurrence. Fibroids are the most common indication for hysterectomy, accounting for approximately one third of hysterectomies, or about 200,000 procedures annually, in the United States. There are many gynecological surgery approaches to fibroid treatment including abdominal, vaginal, conventional laparoscopic, and robotic laparoscopic hysterectomy. Women can choose to conserve their cervix and/or ovaries at the time of hysterectomy. The type of hysterectomy chosen depends on the woman’s medical history, size of the uterus, the woman's medical history, and the skills of her surgeon. Hysterectomy is only an option for women who are not planning future pregnancies.
When fertility is a concern and women wish to preserve their ability to have children, a myomectomy, or removal of the fibroid tumors, is the best gynecological surgery for fibroid treatment. Myomectomies can be performed abdominally (through a horizontal or vertical skin incision depending on the size of uterus), laparoscopically, robotically, or hysteroscopically. Most myomectomies in the U.S. are performed through an abdominal incision; however more minimally invasive options such as laparoscopic or robotic myomectomy are becoming more readily available to women.
Both a laparoscopic myomectomy and robotic myomectomy allow for a quicker recovery and less scar tissue formation as compared to a traditional abdominal myomectomy. These gynecological surgery approaches for fibroid treatment use 3-5 small abdominal skin incisions that are 5-12 mm to perform the same surgery that would have traditionally been performed through a larger abdominal incision. A laparoscope, or thin long camera, and long instruments are inserted through the small incisions to remove the fibroids and then to repair of the uterus.
Robotic myomectomy for fibroid treatment is performed using specialized equipment that allows for free range of motion and a three-dimensional high definition view of the surgical anatomy.
Hysteroscopic myomectomies remove intracavitary or submucous fibroids through the vagina and do not require any abdominal incisions.
There is a risk of recurrence of uterine fibroids after a myomectomy. Studies have found that 25 to 50 percent of women who had myomectomies for fibroid treatment had evidence of their fibroids recurring within one to 10 years.
Other Gynecological Surgery Techniques
Another innovative technique to treat uterine fibroids, Acessa, uses radiofrequency ablation guided with a laparoscopic ultrasound device to treat uterine fibroids. However the number of patients treated by this method has been small and the safety in women desiring pregnancy has not been demonstrated.