Fertility-preserving surgery in which benign fibroids in the uterine muscle are removed by laparoscopic, hysteroscopic, or open techniques while preserving uterine integrity and fertility.
Indication
- Submucosal/intramural fibroids causing heavy or prolonged menstrual bleeding and anemia
- Large fibroids producing pelvic pressure symptoms (urinary frequency, low back/groin pain, constipation)
- Symptoms from rapidly growing fibroids or fibroids unresponsive to medical therapy
- Fibroids associated with recurrent pregnancy loss, infertility, or risk of pregnancy complications (especially submucosal)
- Patients who wish to preserve fertility and prefer myomectomy over hysterectomy
- Recurrent intrauterine bleeding episodes due to submucosal fibroids
Preparation
- Pelvic ultrasound; MRI when needed for fibroid mapping and assessment of number/location
- Complete blood count and hemoglobin level; correction of anemia with iron or transfusion if necessary
- GnRH analogues for temporary volume reduction in selected cases with large or numerous fibroids
- Fasting for 6-8 hours before the procedure; routine work-up, ECG, and anesthesia evaluation
- Counseling about pregnancy plans, preservation of the uterine wall, and possible future cesarean delivery
How it's performed
- For submucosal fibroids: hysteroscopic myomectomy — fibroids are shaved off through a camera passed via the cervix
- For subserosal/intramural fibroids: laparoscopic or robotic myomectomy through small incisions in the umbilicus and lower abdomen, with the fibroid removed via a uterine wall incision
- Open myomectomy (laparotomy) may be preferred for very numerous, very large, or difficult-to-reach fibroids
- After fibroid removal, the uterine wall is closed in multiple layers to restore integrity; sound wall repair is essential for those planning pregnancy
- Excised tissue is generally retrieved in a containment bag rather than with a power morcellator; in-bag techniques are used to avoid disseminating an unsuspected sarcoma
- Temporary tourniquet or vasopressin may be used for bleeding control
Post-procedure
- Same-day discharge for hysteroscopic procedures; 1-2 days for laparoscopic and 2-4 days for open surgery
- Avoid heavy lifting and intercourse for the first 6 weeks
- Review of pathology results and additional consultation if needed
- For those planning pregnancy, waiting 6-12 months is usually advised to allow uterine wall healing
- Mode of delivery in subsequent pregnancies (vaginal/cesarean) is planned according to the quality of wall repair
Risks
- Bleeding (especially with multiple or large fibroids) and possible need for blood transfusion
- Infection, wound problems, thromboembolism, and anesthesia-related complications
- Injury to neighboring organs (bladder, bowel, ureter) — rare
- Possibility of new fibroids developing over time (recurrence)
- Risk of uterine rupture in subsequent pregnancies due to weakened uterine wall (requires planning)
FAQ
Can I become pregnant after myomectomy?
Myomectomy is uterus-sparing surgery and is preferred for patients planning pregnancy. After the recovery period is complete, pregnancy can be planned with physician approval; individual success rates vary.
Can fibroids come back?
New fibroids can develop in different locations after myomectomy (recurrence). The risk depends on age, number of fibroids, and hormonal factors; regular follow-up is important.
Who is a candidate for myomectomy instead of hysterectomy?
Patients who wish to preserve fertility or the uterus and whose fibroids are surgically removable in number and location are candidates. Not all fibroids are suitable; the decision is individualized.
Will my mode of delivery change?
Cesarean delivery may be recommended for subsequent births after myomectomies involving deep uterine wall incisions. The mode of delivery is planned with your obstetrician based on the operative report and wall integrity.
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