Surgical Approaches to Fibroid Treatment: Which One is Right for You?

Uterine fibroids are noncancerous growths that develop in the uterus, affecting millions of women worldwide. While many fibroids are small and do not cause symptoms, larger or multiple fibroids can lead to significant discomfort and impact a woman's quality of life. In such cases, surgical intervention may be necessary to alleviate symptoms and improve overall well-being. However, choosing the right surgical approach can be challenging, as it depends on various factors such as the size, location, and number of fibroids, as well as the patient's desire for future fertility. In this blog, we will explore the different surgical approaches to fibroid treatment  and help you understand which one may be right for you.

 

1. Watchful Waiting and Non-Surgical Options

Before discussing surgical interventions, it is important to note that not all fibroids require immediate surgical treatment. Many women with small fibroids or minimal symptoms can choose a "watchful waiting" approach, where the fibroids are monitored for any changes. Additionally, non-surgical treatments such as hormonal therapy or minimally invasive procedures like uterine artery embolization (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) can be considered alternatives to surgery. These options aim to reduce symptoms and shrink the fibroids without the need for invasive procedures. However, they may not be suitable for all cases, and surgical intervention might be necessary if symptoms persist or worsen.

2. Myomectomy

With a myomectomy, fibroids are surgically removed while leaving the uterus intact. For women who want to keep their fertility or save their uterus for other reasons, it is the best option. There are several ways to do a myomectomy:

 a. Abdominal Myomectomy:  This traditional surgical approach involves making an incision in the lower abdomen to access the uterus. Abdominal myomectomy is typically recommended for large fibroids or multiple fibroids, as it provides better visibility and control during the procedure. However, it requires a longer recovery time and leaves a visible scar.

b. Laparoscopic Myomectomy: Laparoscopic myomectomy is a minimally invasive procedure performed through small incisions in the abdomen. It involves the use of a laparoscope, a thin tube with a camera, and surgical instruments, to remove the fibroids. This approach offers shorter hospital stays, faster recovery, and smaller scars compared to abdominal myomectomy.

c. Hysteroscopic Myomectomy: Hysteroscopic myomectomy is suitable for fibroids that are located inside the uterine cavity or protrude into the cavity. This procedure is performed through the vagina and cervix, without any abdominal incisions. A hysteroscope, a thin instrument with a camera and surgical tools, is inserted through the cervix to remove the fibroids. Hysteroscopic myomectomy is associated with minimal scarring and a faster recovery time.

3. Uterine Artery Embolization (UAE) 

The purpose of uterine artery embolization (UAE), a minimally invasive technique, is to cut off the fibroids' blood supply, forcing them to contract and eventually die. Small particles are injected during UAE into the uterine arteries, which supply the fibroids with blood. Over time, the fibroids diminish as a result of the blood flow obstruction. UAE is often advised for women who do not care about their fertility but wish to avoid surgery or preserve their uterus. Compared to surgery, the technique requires less time to recover from, but there is a slight risk of problems and it could result in transient menopausal symptoms.

4.  Endometrial Ablation

 

 Endometrial ablation is a procedure that aims to destroy the lining of the uterus, reducing menstrual bleeding and alleviating symptoms caused by fibroids. It is a suitable option for women who have completed their childbearing and do not wish to preserve their uterus. Endometrial ablation can be performed through different techniques, including thermal ablation, radiofrequency ablation, and microwave ablation. This procedure is minimally invasive, involves a shorter recovery time compared to surgery, and may significantly reduce or eliminate menstrual bleeding. However, it is not effective in treating large fibroids or those located outside the uterine cavity.

 

5. Hysterectomy

The surgical removal of the uterus is known as a hysterectomy, which is regarded as the only effective treatment for fibroids. Typically, it is advised for women who have finished having children or for whom other treatment choices have proven ineffective or inappropriate. Several methods can be used to perform a hysterectomy:

a. Abdominal Hysterectomy: This is the traditional surgical approach, where an incision is made in the lower abdomen to remove the uterus. Abdominal hysterectomy is usually recommended for large fibroids or when there are other complicating factors. It requires a longer hospital stay and recovery time compared to other approaches, and it leaves a visible abdominal scar.

b. Vaginal Hysterectomy: Vaginal hysterectomy involves the removal of the uterus through the vagina, without any abdominal incisions. This approach offers faster recovery, shorter hospital stays, and no visible scars. However, it may not be suitable for women with large fibroids or certain medical conditions.

c. Laparoscopic Hysterectomy: A minimally invasive surgery called a laparoscopic hysterectomy is carried out through a few tiny abdominal incisions. It entails the removal of the uterus using a laparoscope and medical equipment. Compared to an abdominal hysterectomy, this method has advantages such as shorter hospital stays, quicker healing, and less noticeable scarring.

Conclusion

When it comes to treating fibroids, there are several surgical approaches available, each with its advantages and considerations. The choice of the surgical approach depends on various factors, including the woman's desire for future fertility, fibroid characteristics, and the top fibroid surgeon's expertise. Hysterectomy provides a permanent solution but is not suitable for women who wish to bear children. Myomectomy preserves the uterus and is suitable for women who desire future fertility, with various approaches available depending on fibroid characteristics. Non-surgical options like UAE and MRgFUS offer alternatives to surgery but may have limitations in terms of fibroid characteristics or future pregnancy plans.

It is essential to consult with a gynecologist or a specialist experienced in fibroid treatment to discuss the best surgical approach based on individual circumstances. A thorough evaluation of the fibroid's characteristics, personal fertility goals, potential risks, and recovery times will help guide the decision-making process. With the right surgical approach, women with fibroids can find relief from their symptoms and improve their overall quality of life.