Myomectomy: Procedure, Types, Recovery & Complications

Myomectomy Types and Procedures

Your surgeon may select one of three surgical methods for performing a myomectomy depending on the size, quantity, and location of your fibroids.

Myomectomy of the abdomen

In order to access your uterus and remove fibroids, your surgeon makes an open abdominal incision during an abdominal myomectomy (laparotomy). If it is possible, your surgeon will typically choose to make a low, horizontal ("bikini line") incision. The requirement for vertical incisions arises with larger uteruses.

Robotic or laparoscopic myomectomy

Through a series of tiny abdominal incisions, your surgeon can access and remove fibroids via a laparoscopic or robotic myomectomy, both of which are minimally invasive procedures.

Women who have a laparoscopy instead of a laparotomy experience less blood loss, quicker recoveries, shorter hospital stays, and decreased rates of postoperative problems including adhesion formation. Only a few studies have compared robotic and laparoscopic myomectomy.

• Robotic myomectomy. Small incisions identical to those used in a laparoscopic myomectomy are used to allow entry of the surgical instruments, which are subsequently moved by your surgeon using a separate console. Laparoscopic and robotic myomectomies with a single port (one incision) are now being carried out by some doctors.

• Laparoscopic myomectomy. A small incision is made by your surgeon in or around your abdominal button. A laparoscope, a little tube with a camera attached to one end, is then inserted into your belly. With the use of equipment placed through smaller abdominal wall incisions, your surgeon executes the procedure.

Sometimes, a tiny incision in the abdominal wall is used to morcellate the fibroid and remove it. In some cases, a larger abdominal incision is used to remove the fibroid so that it can be taken out whole. Very rarely, the fibroid may need to be removed by a vaginal incision (colpotomy).

Hysteroscopic myomectomy

Your doctor may advise a hysteroscopic myomectomy to treat submucosal fibroids, which are tiny fibroids that significantly protrude into your uterus. By inserting tools through your cervix and vagina into your uterus, your surgeon can reach and remove the fibroids.

The steps of a hysteroscopic myomectomy include the following:

1. Through your cervix and vagina, your surgeon inserts a tiny, illuminated device into your uterus. He or she will most frequently employ a hysteroscopic morcellator to manually slice the fibroid or a wire loop resectoscope to electrically cut (resect) tissue.

2. To enlarge the uterine cavity and enable uterine wall examination, a transparent liquid—typically a sterile salt solution—is introduced into the uterus.

3. The fibroid is partially removed by your surgeon by shaving off sections with a resectoscope or hysteroscopic morcellator and removing them from the uterus. Large fibroids might require a second surgery to completely eliminate them.

Finally, following a myomectomy procedure, your doctor will give oral pain medicine, instruct you on how to take care of yourself, and brief you on any dietary and activity limitations when you are discharged from the hospital. Depending on the operation you have, you should anticipate some vaginal spotting or stains for a few days to six weeks.