Treatments & Options - Myomectomy
CPT code: 58140
A Myomectomy preserves the uterus: your periods return to normal, and, in most cases, you can have children. Eighty percent of the time, patients have no recurring symptoms. In only twenty percent of women do fibroids recur and require further treatment. There is the potential for scarring, and other normal surgical risks do apply. The excessive bleeding that had once been associated with Myomectomy is no longer a concern with the use of the harmonic scalpel and pitressin, which minimizes bleeding. A myomectomy is a medically recognized, non-experimental procedure.
Uterine Fibroid Tumors Treatment - Myomectomy
A myomectomy removes the fibroid tumor but leaves the uterus and other reproductive organs intact. It preserves childbearing capability and gives you back the active and pain-free life you thought you had lost. There are several types of myomectomy. In determining the best course of action, you and your doctor must consider the location and size of your fibroid tumors.
Abdominal Myomectomy For Large Fibroids
In an abdominal myomectomy, a small incision (sometimes called a "bikini incision") is made across the lower abdomen to expose the fibroids. The fibroids are then individually removed and the uterus is reconstructed to its original shape. Excessive bleeding and transfusions during myomectomies are no longer a concern. Dr. Bartsich uses a harmonic scalpel during surgery, which minimizes bleeding and scarring. A harmonic scalpel is an ultrasound device which separates tissue with high frequency sound waves. Pitressin, a vasoconstricting substance, is also injected into the fibroid to minimize bleeding. He also uses the "cell saver" which retrieves any blood lost during the surgery and immediately retransfuses it to the patient with no additives. These measures virtually eliminate the need for blood transfusions. This operation is usually used for multiple and large fibroids.
A myomectomy is major surgery requiring 2-3 days in the hospital and at least a week's rest at home. After 2-3 weeks a woman can resume normal sexual activity. The operation preserves childbearing ability and can make a dramatic difference in a woman's life. Following extensive surgery substantial scarring can cause uterine rigidity, which may make a cesarean section necessary at the next pregnancy.
Laparoscopic Myomectomy - CPT code: 58551
A laparoscopic myomectomy or minimally invasive surgery is used for smaller fibroids (less than 8cm) on the outside of the uterus. A tiny incision is made in the abdomen for the insertion of a laparoscope, a thin instrument containing a telescope. Through the laparoscope the surgeon views the uterus and surrounding organs and removes the fibroids with instruments that cut and pull the tissue out through thin tubes. There are risks associated with Morcellation, besides organ and vascular injuries, residue tissue fragments can cause pain and infection, seeding of occult unidentified malignant tissue. Appropriate pre-operative screening and counseling of patients is necessary. This procedure is not recommended for women with fibroids in the uterine wall and are still considering pregnancy, as cuts into the uterine wall weaken it and closure is suboptimal. Therefore, uterine rupture during the next pregnancy is possible. Preoperative treatment with Lupron can alter the consistency of the fibroid and make it more difficult to pull out. Recovery time is generally one week.
A more advanced form of minimally invasive surgery - Robotic Assisted Laparoscopic Surgery or da Vinci Surgery, is now frequently used in gynecologic surgery. E.g. Myomectomy, Hysterectomy, ovarian cystectomy etc.
The advantages of Robotic assisted laparoscopic surgeries are 3 dimensional camera vision. The new technology however includes,higher costs,complex surgical setup,lack of tactile feedback and positional problems.
Robotic assisted Laparoscopic surgery has similar limitations as Laparoscopy in regard to size and location of fibroids in patients seeking pregnancy.
Hysteroscopic Myomectomy - CPT code: 58561
The Hysteroscopic myomectomy, which was further developed by Dr. Bartsich at the The New York Presbyterian Hospital, is used for fibroids inside the uterus. It is highly effective in treating fibroids that cause heavy bleeding. Such fibroids may also be the cause of infertility and miscarriages. These fibroids do not respond to hormonal treatment.
The hysteroscope, a small instrument similar to a laparoscope, is inserted through the vagina and cervix into the uterine cavity. A special instrument, called a resectoscope, is used to remove the fibroids after they are resected. Bleeding is rarely a problem and can usually be controlled with the resectoscope. There is a risk of perforation or infection as with any surgery on the uterus. There is no abdominal scar, because there is no incision. It is an outpatient procedure with a recovery period of only 24 hours.