Several new procedures offer alternatives to hysterectomy or myomectomy, especially for the removal of smaller fibroids. An advantage of these new procedures is that they do not involve abdominal surgery. They may be performed on an outpatient basis, or they may require only an overnight hospital stay. Recovery time is usually quicker, too. However, because these procedures are new, many doctors have little experience with them.
Hysteroscopic resection. This procedure uses a hysteroscope, a thin telescope that is inserted through the cervix. It enables the surgeon to see inside the uterus. The surgeon may then remove the fibroids with a laser or an electrical knife, wire, or probe. No incision is made. The procedure may be done with local or general anesthesia. The woman may stay overnight in the hospital or be treated as an outpatient. Full recovery takes a week or two.
Embolization. This procedure shrinks fibroids by cutting off their blood supply. Guided by an X-ray image, the doctor threads a small catheter (a thin flexible tube) through a tiny incision in the groin into the main arteries that supply blood to the uterus. He or she then injects particles of inert plastic through the catheter to block these blood vessels. The uterus itself is not damaged because smaller arteries continue to supply the nutrients and oxygen it needs.
The procedure takes about an hour. It may be performed with local or general anesthesia. The woman must lie flat on her back for six hours afterward to stop bleeding from the incision in the groin. Cramps in the pelvis are common, and the doctor usually prescribes a pain medication for them. Some women may have a fever for a couple of days after the procedure. Some women stay overnight in the hospital, while others go home the same day. Full recovery takes about a week.
Embolization has been used to treat fibroids in the United States for only a few years. Typically, the procedure shrinks fibroids to about half their previous size. The fibroids also become softer and press less on other pelvic organs. It is not known, however, whether the fibroids eventually grow back.
Laparoscopic surgery . Some procedures can be performed using a laparoscope, a pencil-thin surgical telescope similar to a hysteroscope. The surgeon inserts the laparoscope and tiny surgical instruments through one or more small incision in the abdomen.
If the fibroids are small and easy to reach, the surgeon makes an incision in the uterus and removes them. This is called a laparoscopic myomectomy. It may require an overnight hospital stay.
When the fibroids are larger or harder to reach, the surgeon may use a laser or an electric needle to destroy or shrink them. This procedure is known as laparoscopic myolysis. Women who have this procedure done can often go home the same day.
Full recovery from laparoscopic surgery generally takes less than 7 days.