My experience of an almost painless open Myomectomy (Lapratomy)

I am writing this blog post to share my experience of undergoing an open myomectomy- surgical removal of a large fibroid attached to my uterus. My experience has been a successful one, and almost painless that I feel I need to share it with all the women who are exploring surgery options for fibroids. I hope my blog post answers at least some of the questions or doubts.

While undergoing a pelvic ultrasound as part of my first ever annual health checkup, I discovered a large subserosal myoma (commonly known as fibroid) on top of my uterus. Based on the ultrasound, the size was 11x8x8 centrimetres (my first question was to confirm the unit- that it is cm and not mm). The preliminary recommendation from the doctor was to undergo a surgery to remove the fibroid since I am 32 years old and yet to have a child. Given that it was a large fibroid, the doctors advised me to go in for an open myomectomy or a lapratomy. The doctors assured no complication since I had a subserosal fibroid (which means the fibroid is outside the uterus, more like a mushroom). Having understood that it is not an emergency, but something that I need to act on real soon, I wanted to understand my options and make an informed choice.

Open versus Laparoscopic Myomectomy
As any individual in the present generation, to understand about fibroids, I turned to Google and I got all the information that I needed. I had 4 options in front of me- 2 non-invasive techniques that can shrink the fibroid and 2 invasive techniques- laparoscopic surgery and the traditional open surgery. Clearly, given the size of my fibroid and lack of reliable data on possible effects of the procedures, the non-invasive techniques were not my options.
I wanted to consider laparoscopy as my surgical option because the procedure guaranteed lesser blood loss, quicker recovery, and no cutting open the body. Now my health checkup and first opinion was in the city of Coimbatore, Tamil Nadu where my parents live and I wanted to understand my treatment options in the city where I live- Delhi. Clearly Delhi would have better infrastructure and facilities compared to a small town. So, we approached doctors in Delhi to understand my surgery options.
In laparoscopic surgery, the fibroid is basically churned into smaller bits by using a morcelator and absorbed through a pipe. In laparoscopy, if the small bits are not completely removed, there is a chance of these bits growing into individual fibroids in the future. Hence, the morcellation is done inside a bag and the bag is removed making sure there is no spillage. An open surgery is a traditional method of cutting open at the bikini line and clamping the contact between the uterus and fibroid, cutting and removing the fibroid, and suturing the uterus layers and stitching back all the different layers. A laparoscopy would mean recovery in 2 weeks while open myomectomy requires at least 4 weeks recovery.
The more I spoke to my doctor in Delhi, the more I was confused because the approach was very much like the west wherein all possible pros and cons of all procedures were laid out in front of me, all ifs and buts were explained in detail, and if anything goes wrong, the doctor and the team will go in for the foolproof open method. Also, even though the Doctor showed confidence that she could pull off a laparocospic surgery, I was told that given the size of my fibroid, it would not be possible to churn it in a bag (which means greater possibility of spillage). What troubled me the most was that at no time did the doctor suggest what she thought was the best course of action. No matter how much I read up, I am not a doctor to know what the best alternative is. And in the Indian context, we expect the doctors to tell us what is best for us, since they have the expertise. This burden of responsibility to choose my treatment really troubled me.

The Decision
So we turned to our friends and relatives who are gynecologists to get expert opinion. All of them said one thing- “if it was me, I’d recommend an open surgery.” The reasons were that the fibroid is too big, and a lot of time larger fibroids overshadow smaller ones in MRIs and if detected during surgery, would be difficult to pull off through a laparoscopy. My finally verdict, I decided, would be based on my Uncle’s input. He is the Dean of the medical college in Coimbatore and a true well-wisher, not because he is my uncle, but because he is the sort of person who believes in access to best healthcare for all. My uncle suggested the same- go in for the foolproof method of an open surgery. A laparoscopy for a large fibroids are messy. And since it is large, the contact space with the uterus would also be greater. This means that suturing of the uterine wall after the removal of the fibroid needs expert hands, and if not done properly, could result in greater complications in the future, especially during pregnancy. Thus, I decided to go in for an open surgery, and decided to get it done in Coimbatore- where I’ve known the Gynecologist since the time of my puberty, and completely trusted her ability and decisions (and where my parents live).

The Anesthesia Dilemma
My surgery date was fixed for the 30th of March 2016- 5th day of my period so that when it is time for my next period, my uterus would be substantially healed (this is one thing the Delhi doctor did not discuss with me, and I find it disturbing. The surgery was based on her availability than my body clock). I got admitted on the day before. My next big question was the type of anesthesia. Basically there are 2 types- General Anesthesia (GA) and Spinal Anesthesia (SA) and the recent addition of epidural with SA (E&SA). I was presented with GA and ESA and the anesthesiologist suggested that I go in for ESA since they recommend it as a safe option for any surgery in the lower half of the body. GA is where you are completely knocked off, while in ESA, only the lower half of the body is numb and you are aware of what is going on. If that awareness freaks you out, they will sedate you and you go into a happy sleep state (where you respond to questions and are not unconscious).
Too much information can be a bane and having asked some people of their experience of ESA, I was terrified. My friend told me that before her C-section the doctor poked her 5 times in the spine to find the right spot. My sister-in-law gave such a horrible explanation of her epidural experience. I told my Anesthetist I wanted a GA, and she was very unhappy, but reluctantly agreed and sent me to the Head of Gynecology- the Doctor who would be doing the operation.
The Doctor explained that the ESA needle is shorter than the regular injection needle and there is hardly any discomfort. Also, in GA, since you are completely unconscious, they will put a tube in your mouth to ensure respiration, which means coughing and irritation once the tube is out. Also, in ESA, the wearing-off of the numbing is gradual and painkillers can be given accordingly. In GA, the wearing-off is not so gradual and hence, the pain hits you all of a sudden. Once again, trusting my Doctor’s decision, I decided to go in for an ESA, but was having nightmare about it the whole time. It was also decided that I would be given mild dose of epidural for 48 hours to deal with the pain.

The Day of the Surgery
My surgery was scheduled at 9:00 am. I was put on nil-per-oral (no food or water to be consumed orally) for 12 hours before surgery, given a laxative and an enema at 5 am on the day of surgery. I was given saline through IV. By 6:30 my family members arrived, and the situation was so emotional. My mother brought holy ash from her temple, and I also smeared the holy ash my mother-in-law sent from Delhi. By about 7 am the nurses came to check my vitals and gave me the green hospital robe to change into, and informed me that I’d be taken to the Pre-op ward on a stretcher by 8 am. That was the most scared I have ever been. It was as if I was going to war, and as if there was a good probability I was going to end up dead! By 8 the stretcher arrived and so did the flood of tears. I managed to run to the loo before anyone saw me crying, gave myself a strict pep- talk that I was going to come out of this stronger, and walked to the stretcher. I was rolled out with a battalion of my family following me, and my mother had to be stopped and asked to step out of the pre-op ward. That last person I saw before the door close was my sister giving that awkward grin! 🙂
I was brought to the pre-op ward one hour prior to surgery, and I was so thankful for that. Having some time alone, I did some deep breathing exercises, spoke to the lady in the next bed, meditated a little bit, all the while telling myself that it is going to be ok, and I would come out healthier. The men and women who pushed the stretcher to the operating theatre were so kind and encouraging, I am forever thankful to them. By 9:15, I was taken to the operating room, where I have to face the spinal prick.

Spinal Anesthesia was a Breeze!
All the horror stories I had heard about ESA were proven wrong… It took all of 5 mins for the process. At first, she inserted a small catheter (like a little vein) in my spinal column for the epidural post-surgery. I was asked to crawl up into a fetal position to identify the exact location for the injection. The first injection was to numb that space for the actual spinal anesthesia. The local injection was just like any other injection, just a prick. In a matter of seconds the place was numb. Then I could feel a needle piercing my back, but there was no pain and followed by that, I felt trickling of fluids down my spine, a mild tickling of my feet and lower back, and before I knew, my lower back was starting to get numb. I was quickly ordered to turn around and lie on my back, and after that everything went off so very methodically. The first few minutes I couldn’t stop praising my Anesthetist about her Golden Fingers!
On my one hand I had the saline IV and the clip on the finger that monitors heart beat and on the other the instrument measured my BP every 2 minutes (half way into surgery I would start counting to know the exact time when the squeeze would start again). They sedated me mildly, just to ease me into a drowsy state, but I was awake during the entire time of surgery. I heard talk about the size of the fibroid, the location, the noisy interns and juniors getting reprimanded, and some random mobile phone going off. When the fibroid was removed, one of the Anesthetist informed me that it was removed and whether I wanted to see it, my Doctor would make sure that I saw it only when the surgery was completed, and everything was stabilised. The fibroid was a massive pink blob (pink is a sign that is has high vascularity- blood supply and has been growing consistently).
Post-surgery, I was transferred to the post-op room for observation for 3-4 hours. While my numbing was reducing and I could feel a little bit of pain, I was put on .1 level of epidural along with other combination of painkillers to manage post-op pain. The 48 hrs epidural was a blessing. For those 2 days, I felt absolutely NO PAIN. The only drawback was the mild numbing (about 30-40%) of my legs as a result.  Also, during those 48 hours I was asked to lie straight on my back, which was very frustrating especially the last 5-7 hours. But it was totally worth the pain relief. But the numbing was gone after 48 hours, and I was given a set of exercises to strengthen my legs and to reduce discomfort of ESA on my spine.
Today is the 21st of April- about 22 days after my surgery, I am able to climb stairs, I have been going out for about 1.7-2 kms walk every day since the past 3 days (on a slow pace). I do all my work, except for lifting heavy stuff, bending, and sitting on the floor, which would take about 3 months minimum. My next visit to the doctor will be after my period, and I am keeping my fingers crossed that if everything goes well, I should be able to resume work soon…

Moral of the Story
1. It is so important that as a patient, you seek treatment from the doctor you are confident about and truly trust that they have your best interest in mind.
2. Also, rely on doctors who give you advice that they think is best for you rather than letting you make all your decisions.
3. Spinal anesthesia is not as scary as it sounds, in fact it was a breeze. If you have the option of ESA definitely consider it.
4. Ensure you return to your normal life as soon as your body allows you, but expose it to activities gradually.
5. The body is an amazing machine that heals itself so fast and gives you a chance for normal living. I have so much respect and love for my body now that I have undergone a surgery.

I hope my blog has helped you, as a reader, in some way, in the process of your deliberations towards treatment of fibroids.