Myomectomy

When Is Fibroid Surgery Necessary? How Is the Surgical Decision Made?

The presence of fibroids alone is not a reason for surgery. The decision to operate is generally made in the following situations:

• Severe and Uncontrollable Symptoms:
  
  • Development of severe anemia due to heavy and prolonged menstrual bleeding (menorrhagia, hypermenorrhea) that does not respond to medical treatment.
  • Severe pelvic or lower back pain and a feeling of abdominal pressure that reduce daily quality of life.
  • Fibroids pressing on the bladder or intestines, causing urinary or bowel problems.
• Characteristics of the Fibroids:
  
  • Fibroids that have reached a very large size (usually described in terms of gestational weeks, e.g., equivalent to a 12-14 week pregnancy or larger).
  • A very high number of fibroids.
  • Fibroids showing rapid growth in a short time (this can rarely raise suspicion of a malignant tumor — sarcoma — although this is very rare).
• Infertility or Recurrent Pregnancy Loss:
  
  • Especially when submucosal or large intramural fibroids that distort the uterine cavity or press on the tubal openings are thought to be causing infertility or miscarriages.
• Emergencies (Rare):
  
  • Sudden, severe pain resulting from the twisting (torsion) of a pedunculated fibroid.
  • Severe pain due to fibroid degeneration.

The decision to operate is made jointly by Prof. Dr. Nuray Bozkurt and the patient, taking the patient’s condition and preferences into consideration.

Types of Fibroid Surgery: Which Method Is Suitable for Whom? (Options in Ankara)

Fibroid surgeries are essentially classified according to whether the uterus is preserved and how the surgery is performed (open or minimally invasive):

1. Myomectomy (Uterus-Preserving Surgery — Removal of Fibroids Only):

The main goal of this surgery is to remove only the fibroids while leaving the uterus in place. This preserves or enhances the woman’s fertility potential. It is the first-choice method for women who wish to have children in the future or who do not want to lose their uterus. However, there is a risk that the fibroids may recur. Myomectomy can be performed using different surgical approaches depending on the location, number, and size of the fibroids:

• Hysteroscopic Myomectomy:
  
  • How Is It Performed? A thin camera (hysteroscope) and special cutting instruments (resectoscope) are inserted through the cervix, and fibroids that have grown into the uterine cavity (submucosal fibroids) are cut and removed from inside. No incision is made in the abdomen.
  • Advantages: No scarring on the body, minimal pain, very rapid recovery (usually same-day discharge), and a very short return to normal life.
  • Who Is It Suitable For? It is ideal for submucosal fibroids located only within the uterine cavity or with a large portion extending into it, usually smaller than 4-5 cm. It is particularly effective for submucosal fibroids causing heavy bleeding or infertility.
• Laparoscopic Myomectomy (Minimally Invasive Fibroid Surgery):
  
  • How Is It Performed? Under general anesthesia, 3-4 small (0.5-1 cm) incisions are usually made in the abdomen, typically through the navel and the groin area. A camera and thin surgical instruments are inserted into the abdomen through these incisions. Guided by the camera image, the fibroids are carefully removed from the uterine wall. The resulting cavity in the uterine wall is closed with special sutures. The removed fibroids are usually cut into small pieces inside a special bag (morcellation) and removed, or sometimes taken out through the vagina.
  • Advantages: Compared with open surgery, it provides much less postoperative pain, smaller and more cosmetic scars, a shorter hospital stay (usually 1-2 nights), a lower risk of infection, and a much faster return to daily life (1-3 weeks).
  • Who Is It Suitable For? This is the method most commonly preferred today for fibroids located in the uterine wall (intramural) or on the outer surface of the uterus (subserosal) that are usually not very large (e.g., < 10-12 cm) and not too numerous (e.g., < 4-5 fibroids). The surgeon’s laparoscopic experience is very important for the success of this operation.
• Robotic Myomectomy: This is laparoscopic surgery performed using robotic arms controlled by the surgeon from a console. It can offer advantages such as 3D visualization and more precise hand movements for the surgeon. However, it is more costly, and in most cases no clear superiority over standard laparoscopy has been proven.
• Laparotomic (Open) Myomectomy:
  
  • How Is It Performed? Under general anesthesia, the uterus is reached through an incision — usually horizontal (similar to a cesarean incision) or sometimes vertical — made in the lower abdomen. The fibroids are removed under direct vision, and the uterine wall is carefully sutured.
  • Advantages: It allows the safe removal of very large (giant) fibroids, numerous fibroids, or fibroids in hard-to-reach areas of the uterus. The surgeon retains the sense of touch.
  • Who Is It Suitable For? It is performed in situations where laparoscopy would be technically difficult or risky (excessively large or numerous fibroids, significant intra-abdominal adhesions, etc.) or according to the surgeon’s preference.
  • Disadvantages: It carries a larger surgical scar, more postoperative pain, a longer hospital stay (usually 2-4 days), a longer recovery period (usually 4-6 weeks or more), and a higher risk of infection and adhesions.

2. Hysterectomy (Complete Removal of the Uterus):

This surgery offers a definitive and permanent solution for fibroids and their related complaints, because once the uterus is removed, the possibility of fibroid recurrence is eliminated.

• Who Is It Suitable For? It is preferred for women who no longer plan to have children and who have severe, treatment-resistant complaints related to fibroids (especially bleeding and pain), whose fibroids are very large or numerous, or for whom myomectomy would be technically very difficult or risky. It may sometimes also be performed when other gynecological conditions are present besides fibroids (such as adenomyosis or uterine prolapse).
• Surgical Approaches: Hysterectomy can also be performed using different methods:
  
  • Vaginal Hysterectomy: In suitable patients (if the uterus is not too large and prolapse is present), the uterus is removed through the vagina without any abdominal incision. It is one of the least invasive methods.
  • Laparoscopic Hysterectomy (TLH or LAVH): The uterus is removed through small openings in the abdomen using a minimally invasive method. It has clear advantages over open surgery and is frequently preferred today.
  • Robotic Hysterectomy: This is laparoscopic hysterectomy performed with robotic assistance.
  • Abdominal (Open) Hysterectomy: The uterus is removed through an abdominal incision. It is usually performed when the uterus is very large or when other methods are not suitable.
• Status of the Ovaries: During hysterectomy, especially in premenopausal women, the ovaries are generally not removed and are left in place. This allows the woman’s hormone production to continue and prevents sudden menopausal symptoms. The decision on whether to remove the ovaries is made in discussion with the patient, based on her age and additional risk factors.

Factors Considered When Choosing the Surgical Method

Which fibroid surgery (myomectomy/hysterectomy) and which surgical approach (hysteroscopy/laparoscopy/open) is chosen depends on many factors:

• The Patient’s Desire for Children: This is one of the most important determining factors. If the patient wishes to have children, myomectomy is preferred.
• The Patient’s Age and Menopausal Status.
• The Severity and Type of Symptoms.
• The Number, Size, and Location of the Fibroids in the Uterus: These factors particularly determine the surgical approach (minimally invasive/open).
• The Surgeon’s Experience: Advanced surgical techniques such as laparoscopic and hysteroscopic myomectomy in particular require the surgeon’s experience.
• Hospital Facilities: Availability of the equipment required for laparoscopic or robotic surgery.
• The Patient’s General Health Status and Preferences.

At her clinic in Ankara, Prof. Dr. Nuray Bozkurt takes all of these factors into account and decides on the most appropriate surgical method together with the patient.

Risks and Possible Complications of Fibroid Surgery

Fibroid surgeries are generally safe operations, but like every surgical procedure, they carry potential risks:

• Bleeding: More bleeding than expected may occur during or after surgery. The risk of bleeding from the muscular tissue of the uterus is particularly higher with myomectomy than with hysterectomy. A blood transfusion is rarely required.
• Infection: Infection may develop at the surgical wound, within the abdomen, or in the urinary tract.
• Injury to Surrounding Organs: Injury to neighboring organs such as the bladder, ureters (urine ducts), or intestines during surgery is a rare risk.
• Anesthesia-Related Risks: There are risks that vary depending on the type of anesthesia used.
• Blood Clotting (Deep Vein Thrombosis and Pulmonary Embolism): Especially after open surgery, there is a risk of clot formation in the leg veins and of this clot traveling to the lungs (rare but serious). Early mobilization reduces this risk.
• Intra-Abdominal Adhesions: Adhesions may form inside the abdomen after surgery. These adhesions can rarely cause pain or bowel problems and may make future surgeries more difficult. The risk of adhesions is generally lower with laparoscopic surgery.
• Risks Specific to Myomectomy: There is a possibility that fibroids may recur after surgery. In addition, particularly if incisions extending into the deep layers of the uterus were made, there may be a (very rare) risk of uterine wall rupture in future pregnancies, which may require the delivery to be planned as a cesarean section.
• Risks Specific to Hysterectomy: Problems such as opening or infection at the vaginal suture line (cuff) can rarely occur. If the ovaries are removed, sudden menopausal symptoms appear.

Before surgery, Prof. Dr. Nuray Bozkurt will give you detailed information about the risks specific to you. When performed by an experienced surgeon under appropriate conditions, the risk of complications is low.

Recovery Process After Fibroid Surgery

Recovery time varies significantly depending on the type of surgery performed (myomectomy/hysterectomy) and the method used (hysteroscopy/laparoscopy/open):

• Hospital Stay: Usually same-day or next-day discharge after hysteroscopy; 1-2 days after laparoscopy; 2-4 days after open surgery.
• Pain: Postoperative pain is normal and is controlled with painkillers. Pain is generally less with laparoscopic and hysteroscopic methods.
• Wound Care: After open or laparoscopic surgery, the wound site must be kept clean and dry, and dressings should be changed as advised by the doctor. There is no abdominal wound with hysteroscopy.
• Activity: A return to normal daily activities and work is possible within a few days after hysteroscopy, 1-3 weeks after laparoscopy, and 4-6 weeks or longer after open surgery. During this period, heavy lifting, strenuous exercise, and sexual intercourse should be avoided for the period specified by the doctor. Taking short walks early on supports recovery.
• Pregnancy After Myomectomy: It is generally recommended to wait 3-6 months for the uterus to heal after surgery. Your doctor will advise you on the most appropriate timing. The mode of delivery is generally planned as a cesarean section.
• After Hysterectomy: Menstrual bleeding stops permanently and pregnancy is no longer possible. If the ovaries have been preserved, hormone production continues. Sexual activity can generally resume once recovery is complete.

Fibroid Surgery in Ankara: Prof. Dr. Nuray Bozkurt’s Expertise and Experience

Prof. Dr. Nuray Bozkurt offers her patients modern and reliable surgical options for fibroid surgery in Ankara:

• Accurate Indication and Method Selection: She determines the surgical decision and method (myomectomy/hysterectomy; hysteroscopy/laparoscopy/open) according to the patient’s individual situation and priorities, based on evidence-based medical principles.
• Minimally Invasive Surgical Skill: When suitable for the patient, she successfully applies laparoscopic and hysteroscopic surgical techniques that provide faster recovery (or refers the patient to teams experienced in this area).
• Emphasis on Uterus-Preserving Surgery: She prioritizes preserving the uterus and removing only the fibroids (myomectomy), especially in patients who wish to have children, and performs this surgery with great care.
• Safe Surgical Environment: She performs her surgeries in fully equipped, modern, and safe hospital settings in Ankara, together with experienced anesthesia and operating room teams.
• Patient-Centered Care: She provides her patients with detailed information on preoperative preparation, the surgical process, and postoperative follow-up, answers their questions, and offers support.
• Easy Communication: She ensures that her patients can easily reach her during the postoperative period (0538 983 18 78)(0312 284 00 12).

If you need surgery for your fibroids or surgery has been recommended to you, you can consult Prof. Dr. Nuray Bozkurt at our clinic in Ankara to find out which method is best for you, discuss the risks and benefits in detail, and plan your surgical process. To regain your health in experienced hands with modern surgical approaches, please call 0538 983 18 78 to make an appointment.