– Dr. Stanley West
– Dr. Stanley WestLearn More
Dr. West’s extensive experience as a surgeon specializing in myomectomy has shown him that there is no such thing as an impossible myomectomy. Dr. West believes that any woman with fibroids can have the tumors removed and all her organs preserved.
The operation is usually done via an abdominal incision.
The abdominal incision is a small, horizontal “bikini line” incision (known as a Pfannensteil incision) placed an inch above the pubic bone. It is the same incision used for hysterectomy and cesarean section. Don’t let a surgeon convince you that your fibroids are too big to remove through a bikini-line incision. If you can get a full-term baby out of this incision, you certainly can get fibroids out, regardless of their size. If the incision is properly placed and carefully closed your scar will be almost invisible.
Sometimes fibroids can be removed through less extensive surgery using either a laparoscope or a hysteroscope.
Prior to surgery, your doctor needs to know as much as possible about the size and location of the fibroids. This is done through ultrasound.
An ultrasound examination involves beaming sound waves into the abdomen. The test is painless. The sound waves reflect back from internal structures to create an image on a black-and-white television monitor. An experienced radiologist can interpret the images and describe exactly what is in the abdomen so that the surgeon can plan the operation. Dr. West depends on a select few radiologists or does his own ultrasound exams.
Even the most detailed ultrasound images, however, do not reveal everything doctors need to know about the fibroid(s). For instance, ultrasound won't show smaller fibroids lurking underneath a big one. During surgery it isn't surprising to find more fibroids than could be expected on the basis of the ultrasound report. Because of the limitations of ultrasound, surgeons who perform myomectomies must anticipate having to locate and remove fibroids they didn't know were present.
Once the abdomen is open and the fibroids located, the surgeon injects a drug into the fibroid to shut down its blood supply. Once the fibroid turns from its normal red-pink color to a bloodless white, an incision is made in the wall of the uterus with a laser and the fibroid is removed.
As soon as the fibroid(s) have been excised, the surgeon begins to repair the uterine incision in layers.
Once the incision in the uterine wall is closed the surgeon moves on to the second group of fibroids and so on. Finally, every small sign of bleeding is located and sealed off and the abdomen is closed. The stitches are all applied below the surface of the skin, and glue is applied to the surface of the incision. This type of stitching causes less pain and leaves a barely visible scar.
Adhesions – scarring which cause organs to attach to each other; infection, and bleeding. In careful and skilled hands, these types of complications simply do not arise. Steps that prevent the development of complications are as much a part of the surgical process as removal of the fibroids.
The same night the patient will be up out of bed and go to the bathroom. The next morning she will be walking up and down the hall. Patients rarely need pain medication after this surgery. After 24 to 48 hours in the hospital, most women can go home. Showers are not permitted for 48 hours. Bathing, sex and tampons are not permitted until the doctor gives the ok. There may be some intermittent bleeding from the vagina for about four weeks. This is the uterus shrinking back to normal and expelling excess tissue.
The laparoscope is a small viewing device inserted through a small incision near the belly button. Another small incision is made to insert instruments used to remove the fibroid(s).
This procedure is done if the fibroids are close to the surface of the uterus, under 10 centimeters in size, and not too numerous.
Patients spend only one night in the hospital and recover completely within a few days.
The hysteroscope is a viewing device inserted into the uterine cavity through the vagina. This is the preferred surgery if there are only one or two fibroids and if they are located mostly (80% or more) inside the uterine cavity.
Recovery time is similar to laparoscopic surgery.
Dr. West believes that knowing and understanding your options thoroughly can help in the entire process of surgery and recovery. Dr. West will never rush you out of his office and will take the time to collaborate, fully explain, listen, and thoroughly answer all of your questions.