The uterus is a muscle, and fibroids can be described as balls of smooth muscle that form in the lining of the uterus. The exact cause is unknown, but we do know that nearly all uterine fibroids are benign.
Fibroids are very common, occurring in about half of all women. They range in size from a few millimeters to several inches in diameter. Fibroids that cause no symptoms require no treatment, but others need to be surgically removed.
Many women don't feel any symptoms from uterine fibroids. For those who do, symptoms depend on the size and location of the fibroids. Symptoms can include:
- Excessive menstrual bleeding
- Frequency of urination
- Pressure and discomfort
- Interference with fertility
Uterine fibroids are typically discovered during a routine pelvic exam or during an evaluation of symptoms. An ultrasound exam is the most common method of confirming the diagnosis.
Because the vast majority of fibroids are benign, a "watch and wait" approach may be the best option when there are no symptoms. If necessary, treatment may include drug therapy, fibroid embolization, HIFU (high intensity focused ultrasound) or surgery.
Many women who have fibroids do not want their uterus removed. Some are in their child-bearing years and still want to have children. Others simply want to keep their uterus.
Myomectomy involves making an incision in the uterus to remove the fibroid – or making multiple incisions to remove multiple fibroids. It can be a more technically challenging procedure than a hysterectomy because the blood supply to the fibroids can be unpredictable.
After a fibroid is removed, the suturing is done in layers to ensure the integrity of the uterine wall for the possibility of future pregnancy.
Myomectomy can be done via:
- Open surgery: a procedure performed through a large abdominal incision
- Laparoscopic myomectomy: less invasive than open surgery, but difficult to perform and so not widely done
- Robotic myomectomy: an advanced laparoscopic procedure that gives the surgeon better visibility and much more precise suturing ability
Swedish has been at the forefront of robotic myomectomy since it was approved by the FDA in 2005. Patients who have this procedure experience shorter hospital stays, less pain after surgery and a much quicker recovery.
Hysterectomy is the most common method of treating a problem with fibroids – and the only proven method of ensuring they won't grow back.
Options for hysterectomy include:
- Open hysterectomy: surgery that involves a large incision on the abdomen and results in a prolonged recovery
- Vaginal hysterectomy: removal of the uterus through the vagina (if the uterus is not too large)
- Laparoscopic-assisted vaginal hysterectomy: a procedure that uses long-handled instruments and a tiny camera inserted into the abdomen through small incisions
- Robotic hysterectomy: an enhanced minimally invasive procedure operating through small incisions in the abdomen; surgeons use flexible instruments that mimic the human wrist and view the surgical area in 3-D
Robotic hysterectomy is a viable choice for most women who need a hysterectomy. About 60 percent of all hysterectomies at Swedish are now done robotically.
That's because the daVinci Robotic Surgical System we use helps patients have shorter hospital stays, less pain and much quicker recoveries.