What is a myomectomy?

A myomectomy surgically removes only the fibroids and leaves the uterus intact, often preserving fertility.

Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids.

Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary.

To perform a myomectomy, the surgeon may use the following surgical approaches (laparotomy) or less invasive ones (hysteroscopy or laparoscopy).

• Laparotomy.
  
  Laparotomy employs a wide abdominal incision and conventional surgery.
  
  It is used for subserosal or intramural fibroids that are very large (usually more than four inches), that are numerous, or when cancer is suspected.
  
  Using this approach, the physician may be able to feel the fibroids, particularly intramural types, which can be missed during laparoscopy or hysteroscopy.
  
  After the fibroids are removed, careful reconstruction of the uterine wall is critical in both laparotomy and laparoscopy, so that bleeding and infection do not occur.
  
  While complete recovery takes less than a week with laparoscopy and hysteroscopy, recovery from a standard abdominal myomectomy takes as long as six to eight weeks.
  
  It also poses a higher risk for adhesion formation and blood loss than with the less invasive procedures, which is a concern for women who want to retain fertility.
  
  
• Hysteroscopic Myomectomy.
  
  A hysteroscopic myomectomy may be used for submucous fibroids found in the uterine cavity.
  
  With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal.
  
  A wire loop carrying electrical current is then used to shave off the fibroid.
  
  
  TECHNIQUE OF HYSTEROCOPIC MYOMECTOMY
  
  
  
  
  
  
  
  
  
• Laparoscopic myomectomy.
  
  Laparoscopy requires very small incisions.
  
  As with hysteroscopy, a thin scope is employed that contains surgical and viewing instruments.
  
  In centers with extensive experience, laparoscopy has fewer complications, and also shorter recovery time and lower costs than laparotomy.
  
  
• Gasless lift-laparoscopic myomectomy
  
  This our special technique where is a laparoscopic myomectomy is performed without any gas (i.e. CO₂)
  
  For further details about technique and results see our strategy and atlas

Complications And Postoperative Factors.

Any procedure for myomectomy is very complex.

To reduce the risk for complication, patients should seek a surgeon experienced in myomectomies.

Complications that occur during a myomectomy from any procedure include the following:

• Excessive blood loss (higher incidence in laparotomy).
  
• Uterine weakening and rupture during pregnancy.
  
• Subsequent development of scar tissue (called adhesions). There is a higher incidence of adhesions in laparotomy.
  
• Infection.
  
• Damage to the bowel or bladder (higher incidence in laparotomy).

Pregnancies After Myomectomy.

• Studies are finding that pregnancy can be restored in more than half of women after the procedure.
  
• The best candidates for retaining fertility include women with pedunculated and superficial serosal fibroids (stalk-like fibroids that grow out from the uterine surface).
  
• Women with deep intramural fibroids, are at higher risk for infertility after myomectomy.
  
• It should be noted that although studies indicate that between 40% and 58% of women become pregnant after myomectomy, only about a quarter of the women carry their babies to term.
  
• Women who become pregnant subsequently face a higher risk for cesarean section or miscarriage.

Recurrence of Fibroids and Recurrent Surgeries.

• The recurrence rate for fibroid growth after myomectomy is high.
  
• Between 11% and 26% of patients will have recurring fibroids that are severe enough to need additional treatment..