Blog: An Expert Speaks Out

Fibroid Photos: 89 Fibroids Removed by Abdominal Myomectomy

By Paul Indman, MD | March 19, 2011

Dr. Indman believes that women should be as informed as possible so they can be directly involved in making choices about their own health care. This is especially true for the treatment of heavy bleeding. As there are a bewildering number of treatment options available, Dr. Indman takes extra time with his own patients to be sure they make the best possible individual decisions. Dr. Indman has helped pioneer techniques in Gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals.

Deborah, a 54 year old woman from the Midwest, called stating that her uterus had multiple fibroids which have grown over the last two years, and she wanted to avoid a hysterectomy for personal reasons. She was having regular menstrual periods and lab work (FSH) showed that she was not yet menopausal, and was quite uncomfortable from the pressure of her huge uterus and heavy menstrual bleeding. An MRI was ordered, in which over 30 fibroids were identified. The MRI is shown below:

When she came to see me her uterus was almost to her ribcage. I did an office hysteroscopy which showed a large submucous fibroidin addition to the fibroids in the wall. This was important to know about beforehand, as it would have caused continued heavy bleeding if it was left behind. We talked about all treatment options, including embolization (UFE) and hysterectomy. Since she chose to have an abdominal myomectomy, we agreed that a hysterectomy would only be done in the very unlikely event of an unexpected finding that would threaten her life.

Here is a photo of Deborah’s uterus during her myomectomy. A horizontal incision was made, and her uterus containing the fibroids is shown below. Her legs are to the left of the photo.

A total of 89 fibroids were removed, which are shown below.

Comment: A number of treatment options were possible for Deborah. Embolization (UFE) would have avoided an incision, but even if it decreased significantly in size it still would be huge. She also had a submucous myoma, which could cause problems after emboliztion. I had suggested that because of the large number of fibroids hysterectomy would be simpler than a myomectomy, and require less surgical time. She could still keep her overies and her cervix. (Hysterectomy would not be an option for someone desiring pregnancy.) I feel my job is to present as objectively as I can the advantages and disadvantages of all the options. Since women have different needs and beliefs, what is best for one person may not be the same as what is best for another.Deborah chose an abdominal myomectomy, and was able to go home with her uterus intact. — Paul Indman, M.D.

Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.

by mamta sahu | June 01, 2012 10:32 AM EDT

Myomectomy was a good decision since rare chance of hysterectomy was acceptable to patient. Otherwise also before embolisation technique the choice was between hysterectomy and myomectomy only .....

AboutOurBloggers

	GUEST BLOGGER David Holtz, MD David Holtz is a practicing Gynecologic Oncologist with Main Line Gynecologic Oncology Associates and the Director of the Division of Gynecologic Oncology for the Main Line Health System. He is the first gynecologic surgeon in Pennsylvania to perform procedures for uterine and cervical cancer with the daVinci Robot, and he is a Clinical Assistant Professor with Thomas Jefferson University Hospital and the Lankenau Institute for Medical Research. Dr. Holtz’s clinical interests include minimally invasive surgery for women’s cancers and nanoparticles in the treatment of ovarian cancer.
	GUEST BLOGGER Donald Shuwarger, MD Dr Don Shuwarger is a board-certified general ob/gyn practicing in northwest North Dakota. His career spans 26 years, most of which has been spent serving smaller cities. He earned his MD from Baylor College of Medicine in 1981 where he completed his ob/gyn residency in 1985. He earned his MBA from UMass-Amherst in 2005. In 2008 Shuwarger took a sabbatical to join the US Antarctic Program as a physician at McMurdo Station and the new Amundsen-Scott South Pole Station. From 2009 - 2010 he was the Chief Medical Officer at the US Army Kwajalein Atoll in the Marshall Islands. He has one 22 year old daughter who is an EMT and is studying to be a registered nurse.
	GUEST BLOGGER Amy Tuteur, MD Dr Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College, her medical degree from Boston University School of Medicine, and did her internship and residency at Boston's Beth Israel Hospital. Dr Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. She blogs at The Skeptical OB.
	ISSUES IN INFERTILITY Reproductive Medicine Associates of New York RMA of New York offers patients up-to-date, appropriate infertility treatment in a caring, compassionate manner.
	ISSUES IN INFERTILITY Eric Flisser, MD Dr Flisser, MD is the Medical Director of Reproductive Medicine Associates of New York. He is Board Certified in Reproductive Endocrinology & Infertility and in Obstetrics & Gynecology. He is an Associate Member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. He is also a member of the Nassau County Obstetrics and Gynecology Society, New York-Metropolitan Embryologist Society, and the American College of Obstetricians and Gynecologists. His professional interests include reproductive surgery, in vitro fertilization, and oocyte donation.
	ULTRASOUND Joe Antony, MBBS, MD Dr Antony's expertise includes radio diagnosis, ultrasound and color Doppler imaging, x-ray imaging, CT imaging, and MR imaging. Presently, he is a consultant radiologist at PVS Hospital in Cohin, Kerala, India and is consultant radiologist and CEO of Ultrascan Centre, which is a color Doppler and ultrasound imaging clinic in Cochin, India.You can see his full ultrasound gallery at ultrasound-images.com and sites.google.com/site/drjoea. He blogs at cochinblogs.blogspot.com and ultrasound-images.blogspot.com.
	UTERINE FIBROIDS Paul Indman, MD Dr Indman, MD has helped pioneer techniques in gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals. Dr Indman is an editorial advisor on OBGYN.net. You can read more about him and his work on his eFibroids Web site.

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