Myomectomy (Open/Laparoscopic/Robotic)

Myomectomy

A myomectomy is a surgical procedure to remove uterine fibroids (benign growths) while keeping the uterus intact. Unlike a hysterectomy, it preserves fertility and is the preferred option for women who wish to become pregnant or maintain their uterine health. This procedure specifically targets the fibroids while surgically repairing the uterine wall.

When You Should Consider a Myomectomy

• Fertility Preservation: For women who plan to have children in the future and need to keep the uterus functional.

• Heavy Menstrual Bleeding: When fibroids cause anemia, flooding, or prolonged periods that disrupt daily life.

• Pelvic Pain or Pressure: Large fibroids pressing on the bladder (causing frequent urination) or the rectum.

• Infertility or Miscarriage: When fibroids distort the uterine cavity and interfere with embryo implantation or maintenance of pregnancy.

• Rapid Growth: If ultrasound monitoring shows fibroids are growing quickly, even if they are currently asymptomatic.

Surgical Approaches

• Abdominal Myomectomy (Open): A traditional "bikini cut" horizontal incision is made in the lower abdomen. This is used for very large fibroids (typically over 10 cm), numerous growths, or those buried deep in the uterine wall.

• Laparoscopic Myomectomy: Performed through 3–4 tiny "keyhole" incisions. The surgeon uses a camera and specialized tools to cut the fibroids into smaller pieces (morcellation) for removal through the small ports.

• Robotic-Assisted Myomectomy: Similar to the laparoscopic approach, but the surgeon operates via a robotic console. This provides superior 3D visualization and greater precision, which is helpful for complex or hard-to-reach fibroids.

• Hysteroscopic Myomectomy: No abdominal incisions are made. A specialized scope is inserted through the cervix to remove fibroids that are bulging into the uterine cavity (submucosal fibroids).

How Is Performed

• Anesthesia: The surgery is performed under general anesthesia and typically takes between 1 to 3 hours depending on the number of fibroids.

• Incision and Access: Depending on the approach, the surgeon accesses the uterus either through the abdomen or the vaginal canal/cervix.

• Fibroid Removal: Each fibroid is carefully "shelled out" from the surrounding healthy uterine muscle.

• Uterine Reconstruction: The surgeon meticulously sutures the layers of the uterine muscle back together to ensure the wall is strong enough to support a future pregnancy.

• Closure: Abdominal incisions are closed with stitches or surgical glue. For hysteroscopic cases, there are no external wounds to close.

Pre-Procedure Preparation

• Pelvic Imaging: An MRI or detailed ultrasound is mandatory to map the exact size, number, and depth of all fibroids.

• Hormonal Therapy (Optional): In some cases, medication (like GnRH agonists) may be prescribed for 2–3 months before surgery to shrink the fibroids and reduce blood loss.

• Iron Supplementation: If you are anemic due to heavy bleeding, you may need to take iron to build up your blood count before surgery.

• Fasting: Adhering to strict "nothing by mouth" instructions for at least 8 hours prior to your general anesthesia.

• Medication Audit: Stopping blood thinners, aspirin, or anti-inflammatory drugs 7–10 days before the procedure.

Tests Before Myomectomy

• Saline Infusion Sonogram (SIS): Injecting sterile water into the uterus during an ultrasound to get a clear view of the uterine lining.

• Hysteroscopy (Diagnostic): A quick office procedure to look inside the uterus and confirm if fibroids are affecting the cavity.

• Blood Panels: Checking hemoglobin and hematocrit levels to assess for anemia.

• ECG: A standard heart check to ensure you are healthy enough for the administration of anesthesia.

Life After Myomectomy

• Hospital Stay: Usually 1–2 nights for open surgery; often same-day discharge or one night for laparoscopic and robotic approaches.

• Physical Activity: Walking is encouraged immediately to prevent blood clots. Avoid heavy lifting and strenuous exercise for 4 weeks (laparoscopic) to 6 weeks (open).

• Pregnancy Timing: Surgeons usually recommend waiting 3 to 6 months before trying to conceive to allow the uterine wall to heal completely.

• Delivery Method: If the surgery involved deep incisions into the uterine wall, a C-section is often required for future deliveries to prevent uterine rupture during labor.

• Follow-up Imaging: A repeat ultrasound is often done 3–6 months post-op to ensure the uterus has healed well and no small fibroids were left behind.

Why Specialized Treatment Is Highly Effective

• Preserves Reproductive Potential: Unlike a hysterectomy, this procedure keeps the option of biological motherhood open.

• Targeted Symptom Relief: Successfully removing fibroids eliminates the source of heavy bleeding and pelvic pressure while keeping the organ intact.

• High Success Rates: Modern robotic and laparoscopic techniques allow for the removal of complex fibroids with minimal blood loss and faster recovery.

• Improved Fertility Outcomes: For many women, removing cavity-distorting fibroids significantly increases the chances of successful natural conception or IVF.

• Maintains Pelvic Integrity: Keeping the uterus helps maintain the natural support of the pelvic floor and avoids the early onset of surgical menopause.