Overview
Myomectomy is the surgical removal of uterine fibroids while preserving the uterus. A laparoscopic approach may be appropriate for selected patients depending on fibroid size, number, and location. This procedure is particularly valuable for women who wish to preserve fertility or avoid hysterectomy.
Indications
- Symptomatic fibroids (heavy bleeding, pelvic pressure, pain)
- Fibroids contributing to infertility
- Desire to preserve the uterus
- Fibroids amenable to minimally invasive removal based on size and location
The Procedure
Through 3-4 small abdominal incisions, the fibroid is identified, enucleated (shelled out) from the uterine muscle, and the uterus is repaired in layers using sutures. A specimen is removed through one of the incisions, sometimes using a technique called morcellation.
Recovery
- Hospital stay: typically 0-1 night
- Return to light activities: 1-2 weeks
- Full recovery: approximately 4-6 weeks
- Heavy lifting restriction: usually 6 weeks
Considerations
- Fibroid recurrence is possible, as new fibroids may develop from any remaining cells
- Uterine scar from myomectomy may influence future delivery planning (cesarean section may be recommended)
- Not all fibroids are suitable for laparoscopic removal; very large or numerous fibroids may require an open approach
- Hysteroscopic myomectomy is preferred for fibroids that protrude into the uterine cavity
Risks and Success Rates
Laparoscopic myomectomy is effective for relieving symptoms caused by fibroids while preserving the uterus. Potential risks include:
- Bleeding — occasionally significant, with a small risk of requiring transfusion or conversion to hysterectomy
- Fibroid recurrence — new fibroids may develop over time, with some women eventually requiring repeat surgery or hysterectomy
- Adhesion formation — scar tissue may form after surgery, potentially affecting fertility or causing pain
- Injury to surrounding structures — uncommon
- Uterine rupture in future pregnancy — rare but recognized risk, particularly with deep myometrial entry; delivery planning should be discussed with your obstetrician
- Conversion to open surgery — occasionally necessary depending on fibroid size or location