Myomectomy is surgery to remove uterine fibroids. Uterine fibroids are growths of tissue that develop in the uterus and are almost always noncancerous. Myomectomy leaves the uterus intact, so people can still become pregnant after the procedure.

What is a myomectomy?

Myomectomy removes uterine fibroids, also called leiomyomas. Fibroids are defined according to where they occur in the uterus, and can be of various sizes:

• Intramural fibroids: within the muscular uterine wall
• Submucosal fibroids: just beneath the uterine lining
• Subserosal fibroids: on the outside of the uterine wall

For people who want to get pregnant or prefer to preserve the uterus, myomectomy is an alternative to hysterectomy (surgery to remove the uterus) for the treatment of fibroids.
Myomectomy is recommended when fibroids become symptomatic or when their location affects fertility. If a patient has difficulty getting pregnant, fibroids that affect the uterine cavity may need to be removed.  

Myomectomy can help relieve:

• Bleeding between periods
• Heavy menstrual bleeding
• Iron-deficiency anemia caused by blood loss
• Pelvic pain, back pain and pelvic pressure
• Bulk symptoms (a term used to describe the physical discomfort and pressure caused by uterine fibroids), such as frequent urination, difficulty with urination, constipation, pain with intercourse 

The procedure can also reduce the risk of serious health complications. If fibroids are located within the endometrial cavity, they can increase the chances of a miscarriage during the second trimester of pregnancy. In rare cases, fibroids can cause compression of major veins and lead to life-threatening blood clots or affect nearby organs like the bladder, intestines or ureters.

Types of Myomectomies

There are several types of myomectomies. The procedure that is right for you will depend on several factors, including the location, number and size of uterine fibroids to be removed.

Abdominal myomectomy

An abdominal, or open, myomectomy requires the longest recovery and carries some additional risk compared with the other approaches to myomectomy, but it is recommended in specific cases when the benefits outweigh the risks. The decision to recommend an abdominal myomectomy depends on the size and number of fibroids present. During the procedure, your surgeon makes an incision (cut) in your abdominal wall. The incision is usually horizontal and low on your belly, around the same location as a C-section incision. Or, if a woman has a large uterus, fibroids high in the uterus or a scar from previous abdominal surgery, your surgeon may make a vertical midline incision.

For an abdominal myomectomy, you can expect:

• Anesthesia: general, with a breathing tube
• Hospitalization: one to two days
• Incision size: Horizontal incisions are about 4 inches; midline incisions are longer.
• Procedure time: two to three hours
• Recovery: four to six weeks

Abdominal myomectomy benefits and risks

An abdominal myomectomy carries more risks than a less invasive procedure, including:

• Excessive bleeding, need for blood transfusion
• Infection
• Longer recovery
• Pain
• Scarring
• Higher risk of hernia

Uterine rupture during pregnancy is a risk for the abdominal and laparoscopic approaches. But there are some benefits to an abdominal myomectomy. The surgeon has greater access to the fibroids, so they are able to palpate (touch) them within the uterine wall and locate them more easily. It can also be a shorter procedure than minimally invasive alternatives like laparoscopic or robotic myomectomy since morcellation (the process through which tissue such as that from the uterus or fibroids is cut into smaller pieces for removal) would not be required. Open surgery may be recommended if a patient has many fibroids or very large fibroids.

Abdominal myomectomy recovery

Recovery after abdominal myomectomy takes four to six weeks. During this time, avoid heavy lifting or any type of strenuous activity. Depending on your job, you may need to take four to eight weeks off work.

It’s important to stay mobile during recovery by walking each day. Becoming sedentary can increase the risk of deep vein thrombosis, which is blood clots in the legs that can travel to the lungs (pulmonary embolism) and become life-threatening. You can also lose muscle mass and become deconditioned, which further prolongs recovery.

Laparoscopic or Robotic-assisted myomectomy

Laparoscopic myomectomy is a minimally invasive procedure to remove uterine fibroids. A surgeon makes four tiny incisions in your abdomen then uses a laparoscope, which is a special instrument that contains a light and video camera, to operate through the incisions. Your surgeon views the surgery on a video monitor.

Robotic-assisted laparoscopic myomectomy is another type of minimally invasive surgery to remove fibroids. The surgeon controls robotic arms that help perform the procedure with precision through small incisions. 

For a laparoscopic or robotic-assisted myomectomy, you can expect:

• Anesthesia: general
• Hospitalization: none (usually an outpatient procedure)
• Incision size: 5–12 millimeters
• Procedure time: three to four hours
• Recovery: two to three weeks

Robotic-assisted and laparoscopic myomectomy benefits and risks

Most myomectomies should be performed laparoscopically, as very large fibroids can be removed using this technique. It is a longer procedure in the operating room, but it carries fewer risks and has a shorter recovery compared with abdominal myomectomy.

There is less bleeding during surgery, so patients are less likely to need a blood transfusion. It also causes less trauma to the abdominal wall, which lowers the risk of adhesions. Incisions are smaller, so the risk of hernia is lower. Patients recover faster and with less pain.

Similar to the abdominal approach, robotic-assisted and laparoscopic procedures require uterine incisions that weaken the myometrium. The incisions of the myometrium seen with the abdominal, laparoscopic and robotic approaches to myomectomy can increase the risk of uterine rupture during pregnancy and labor, so women who have these procedures need C-sections during delivery in future pregnancies.

Robotic-assisted and laparoscopic myomectomy recovery

Recovery after minimally invasive myomectomy takes two to three weeks. Plan on taking three weeks off work. Some people may be more mobile after a laparoscopic or robotic-assisted myomectomy, because there is less pain from the small incisions. But you may still feel fatigued as your body heals.

Hysteroscopic myomectomy

Hysteroscopic myomectomy is the most minimally invasive procedure to treat fibroids. A surgeon removes fibroids by inserting a hysteroscope into the uterine cavity through the vagina and cervix. A hysteroscope is a rigid tube with a light that has an operative element that can remove fibroid tissue. Hysteroscopic myomectomy is performed entirely through the natural orifices of the vagina and cervix, so no incisions are made.

For a hysteroscopic myomectomy, you can expect:

• Anesthesia: general or sedation
• Hospitalization: none
• Incision size: none
• Procedure time: under 90 minutes
• Recovery: 48 hours

Hysteroscopic myomectomy benefits and risks

Only certain types of fibroids can be removed with hysteroscopic myomectomy, so not everyone will be a candidate for this procedure. Your surgeon may recommend the procedure if you have fibroids that are:

• Not deep in the uterine wall
• Smaller than 4 centimeters
• Submucosal

A hysteroscopic myomectomy does not cause any trauma to the uterine wall, so it does not increase the risk of complications during pregnancy. And since it does not require any incisions, patients have no scarring and a fast recovery.

Hysteroscopic myomectomy recovery

Most people only need one to two days to recover from a hysteroscopic myomectomy, and may return to work as soon as they feel ready.

Myomectomy and Pregnancy

The main benefit of myomectomy is that it preserves fertility, so people can still become pregnant after fibroid removal. The procedure may even improve fertility if fibroids are preventing pregnancy. However, abdominal and laparoscopic myomectomies require incisions that compromise the myometrium. This increases the risk of uterine rupture during pregnancy and labor. People who have had an abdominal or laparoscopic myomectomy will often need a C-section during delivery.

It is also important to know that it may not be possible to remove every fibroid that is present, and fibroids may recur if menopause hasn’t been reached.