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Dr. West said he would remove all my fibroids [25 of them] with a bikini cut incision…everything Dr. West promised was delivered. I feel better as each day passes. He has raised the bar.

–Sandy Dennis, New York

Dr. Stanley West removed 19 fibroids from my uterus, [even though] I was told by my local doctors that hysterectomy was my only option.

–Debbie Travis, Woodbine, Georgia

I have never had a doctor speak to me the way Dr. West did. I had my surgery and everything went exactly the way he said it would. The day after surgery, my friend and I were dancing in the hospital hallway (modified of course!!)

–Alison B., New York

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Myomectomy

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 Incision

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.

Preparation for Surgery

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.

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.

Understanding Myomectomy

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.

Complications of Myomectomy

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.

Recovery from Myomectomy

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.

Laparoscopic Myomectomy

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.

Hysteroscopic Myomectomy

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.

Know Your Options

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.

Questions to Ask When Surgery is Recommended

  1. Why are you recommending surgery at this time?
  2. What can I expect to happen if I decide against surgery?
  3. Do you do myomectomies? How often? (If infrequently, this is not the doctor for you.)
  4. Can you do a myomectomy regardless of the size and number of fibroids?
  5. Will you require me to authorize you to perform a hysterectomy if you cannot complete the myomectomy or if complications develop?
  6. How likely is it that you will decide on a hysterectomy once the surgery begins – how many of your patients who go in for myomectomy receive hysterectomies?
  7. Are you contemplating abdominal, vaginal, or laparoscopic surgery? Why?
  8. What sort of incision will you make? If not a Pfannensteil (bikini line) why not?
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