Each surgical technique carries risks:
- Laparotomy and Laparoscopy procedures carry a higher haemorrhage risk than operative hysteroscopy. However bleeding is for the most part very light. For situations where there are many large myomas to be removed, as a precautionary step blood vessels to the uterus may be blocked before the procedure. Very rarely a patient may require a blood transfusion during removal of myomas or immediately after their removal. This may be the case if the patient’s red blood cell count is too low. Clearly the surgeon looks to circumvent this event and acts as precisely and as rapidly as is possible and should of course be experienced in hemostasis management.
- Adhesions: uterine scars may adhere to neighboring parts such as the intestines or the greater omentum
- future pregnancy planning should be discussed with the surgeon as regards both the timing of any future pregnancy and the way of delivery (in general a patient should wait about 6 months between surgery and pregnancy).
Myomectomy is one of many surgical procedures carried out in the pelvic area and as such carries risks associated with the type of access:
- bruising may occur at any access points (around the scar tissue) although this is very rare
- infections may occur at the scar tissue (abcesses)
- urinary infections may occur
- Non-surgical but related risks, for example those due to bed rest include phlebitis and pulmonary embolism. These risks require patients to wear support stockings and take anti-coagulant medication as prescribed and monitored by the anaesthetist.
This is not an exhaustive listing of the risks.
- Myomectomy via hysteroscopy carries much fewer risks which are associated with the surgical access point. Complications during this kind of procedure are very rare (<2%)
Access via the cervix requires that the cervix be dilated, generally with an anesthesia. The risks here include:
- Cervical tears
- Perforation of the uterine wall by the dilatation devices
- Uterine wall perforation during myoma removal
- Incomplete myoma removal
- Post-operative bleeding (very rare)
- Infection (extremely rare)
- Uterine adhesions
