What is Myomectomy surgery (for uterine fibroid removal)?
Myomectomy refers to surgery to remove uterine fibroids, also known as myomas. The goal of a myomectomy is to treat symptoms of uterine fibroids, leaving the uterus intact, and improve fertility outcomes for some women.
What Conditions can a Myomectomy Treat?
A myomectomy treats the symptoms of uterine fibroids without having to remove the entire uterus (hysterectomy). Many women choose to have a myomectomy if they wish to become pregnant in the future. A myomectomy can treat:
- Anemia and/or irregular bleeding due to uterine fibroids
- Pelvic pain and pressure that cannot be managed with medication
- Infertility or recurring miscarriages due to uterine fibroids
For women who have a certain type of uterine fibroid, called a submucosal fibroid, a myomectomy can also increase your chances of getting pregnant.
How are Myomectomies Performed?
A myomectomy can be performed in one of three ways. The method your surgeon chooses may depend on the number, size, and location of your myomas.
This type of surgery is conducted through a large incision in the abdominal wall. Your surgeon will have a clear view of your pelvic organs and will remove the tissue through the incision. It is the best choice of procedure for removing large fibroids, more than 2 fibroids, or fibroids that are deeply embedded in the uterine wall.
A laparoscopy is performed through several small incisions in the abdomen. The surgeon inserts the thin, flexible laparoscope into an incision and views the organs through a special lens at the end of the instrument. Laparoscopy is typically used when there are only one or two fibroids to be removed, and only if they are less than 2 inches in diameter.
In this outpatient procedure, the doctor will insert a hysteroscope through the vagina and cervix in order to view the inside of the uterus. This surgery is typically only recommended for removing fibroids that have developed on the inner lining of the uterine cavity.
Unfortunately, too few surgeons perform this Myomectomy surgery laparoscopically on an outpatient basis. I do over 99% of mine this way. For more information about our advanced outpatient surgical procedures, please visit our Outpatient Hysterectomy Center website.
Risks of Myomectomy
All surgical procedures carry some risk. Your doctor will explain the risks to you and take every precaution during surgery. Risks of myomectomy include:
- Damage to pelvic tissue (uterus, fallopian tubes, ovaries, bladder, bowel)
- Scarring (adhesions) that may cause pain or infertility
- Scarring that may rupture during pregnancy or childbirth
- Infection of the ovaries, fallopian tubes, or uterus
- Heavy, uncontrolled bleeding that may require a hysterectomy
Your recovery from a myomectomy depends on the type of surgery you have had.
- Abdominal – 1-3 days in the hospital, 4-6 weeks recovery
- Laparoscopy – 0-1 days in the hospital, 1-2 weeks recovery
- Hysteroscopy – No hospital stay, 3-14 days recovery
It’s relatively common for fibroids to return even after a myomectomy. Experts estimate that between 1-5 out of every 10 women who have a myomectomy will experience reoccurring uterine fibroids. If you had multiple or large fibroids, you are more likely to have more uterine fibroids return.
Pregnancy after Myomectomy
Patients who have a myomectomy in order to improve their chances of having a baby should try to get pregnant soon after the surgery. This is because as time passes, the odds of fibroids re-developing are higher.
If you get pregnant following a myomectomy, there’s a slightly increased risk of complications involving the placenta, such as placenta abruptio or placenta accreta. Additionally, your doctor may recommend delivery via Cesarean section, depending on the size and location of the surgical site and how likely it is that your surgical scars will affect labor.