Myomectomy

Myomectomy is a type of surgery used to remove uterine fibroids. Your doctor might recommend this surgery if your fibroids are causing symptoms such as:

A myomectomy can be done one of three ways:

Abdominal myomectomy lets your surgeon removes your fibroids through an open surgical cut in your lower belly.

Laparoscopic myomectomy allows your surgeon to remove your fibroids through several small incisions. This may be done robotically. It’s less invasive and recovery is faster than with abdominal myomectomy.

Hysteroscopic myomectomy requires your surgeon to use a special scope to remove your fibroids through your vagina and cervix.

Myomectomy is an option for women with fibroids who wish to get pregnant in the future, or who want to keep their uterus for another reason.

Unlike a hysterectomy, which takes out your entire uterus, myomectomy removes your fibroids but leaves your uterus in place. This allows you to try for children in the future.

The type of myomectomy your doctor recommends depends on the size and location of your fibroids:

Most of these fibroids are undetected; however these may be incidentally discovered during a pelvic or gynecologic exam or during prenatal care.

Before you have surgery, your doctor may prescribe medication to reduce the size of your fibroids and make them easier to remove.

Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are drugs that block production of estrogen and progesterone. They will put you into temporary menopause. Once you stop taking these medications, your menstrual period will return and pregnancy should be possible.

When you meet with your doctor to go over the procedure, make sure you ask any questions you have about preparation and what to expect during your surgery.

You might need tests to make sure you’re healthy enough for surgery. Your doctor will decide which tests you need based on your risk factors. These can include:

You may have to stop taking certain medications before your myomectomy. Tell your doctor about each medication you take, including vitamins, supplements, and over-the-counter medications. Ask your doctor which drugs you’ll need to stop taking before your surgery and how long you’ll need to stay off them.

If you smoke, stop six to eight weeks before your surgery. Smoking can slow your healing process as well as increase your risk of cardiovascular events during your surgery. Ask your doctor for advice on how to quit. You will need to stop eating and drinking by midnight the night before your surgery

The procedure will differ depending on what type of myomectomy you’re having.

Abdominal myomectomy: During this procedure, you’ll be placed under general anesthesia. Your surgeon will first make an incision through your lower abdomen into your uterus. This can be done in a couple of ways:

A horizontal incision 3 to 4 inches long, just over your pubic bone. This type of incision causes less pain and leaves a smaller scar but may not be big enough to remove large fibroids.

A vertical incision from just below your belly button to just above your pubic bone. This incision type is rarely used today but it may work better for larger fibroids and cuts down on bleeding.

Once the incision is made, your surgeon will remove your fibroids from your uterine wall. Then they’ll stitch your uterine muscle layers back together.

Most women who have this procedure spend one to three days in the hospital.

Laparoscopic myomectomy: While you’re under general anesthesia, your surgeon will make four small incisions. These will each be about ½-inch long in your lower abdomen. Your belly will be filled with carbon dioxide gas to help the surgeon see inside your abdomen. The surgeon will then place a laparoscope into one of the incisions. A laparoscope is a thin, lighted tube with a camera on one end. Small instruments will be placed into the other incisions. If the surgery is being done robotically, your surgeon will control the instruments remotely using a robotic arm. Your surgeon may cut your fibroids into small pieces to remove them. If they are too large, your surgeon may change to an abdominal myomectomy and make a larger incision in your abdomen. Afterward, your surgeon will remove the instruments, release the gas, and close your incisions. Most women who have this procedure stay in the hospital for one night.

Hysteroscopic myomectomy: You will get a local anaesthetic or be placed under general anesthesia during this procedure. The surgeon will insert a thin, lighted scope through your vagina and cervix into your uterus. They’ll place a liquid in your uterus to widen it to allow them to see your fibroids more clearly. Your surgeon will use a wire loop to shave off pieces of your fibroid. Then, the liquid will wash out the removed pieces of fibroid.  You should be able to go home the same day as your surgery.

Any surgery can have risks, and myomectomy is no different. Risks of this procedure are rare, but they can include:

Call your doctor if you have any of these symptoms after your procedure:

You will have some pain after your surgery. Your doctor can provide medication to treat your discomfort. You’ll also have spotting for a few days to weeks. How long you’ll have to wait before returning to your normal activities depends on what type of procedure you have. Open surgery has the longest recovery time.

Recovery times for each procedure are:

Don’t lift anything heavy or exercise strenuously until your incisions have fully healed. Your doctor will let you know when you can return to these activities.

Ask your doctor when it’s safe for you to have sex. You may have to wait up to six weeks.

If you want to get pregnant, ask your doctor when you can safely start trying. You might need to wait three to six months for your uterus to fully heal depending on which kind of surgery you’ve had.