myomectomy

Myomectomy is a surgical procedure to remove uterine fibroids (leiomyomas) while preserving the uterus. Fibroids are noncancerous growths of smooth muscle tissue that can cause heavy bleeding, pelvic pain, pressure, and infertility in some individuals.

Indications include symptomatic fibroids that affect quality of life or fertility, or fibroids to improve conception chances. Myomectomy is typically considered when uterine preservation is desired, or when childbearing is planned. It is generally not used when there is a suspicion of uterine cancer or when fibroids are extremely large or numerous and hysterectomy offers a better outcome.

There are several surgical approaches. Abdominal myomectomy is an open operation through an incision in the abdomen and is often chosen for large or multiple fibroids. Laparoscopic myomectomy and robot-assisted laparoscopic myomectomy use small incisions and specialized tools. Hysteroscopic myomectomy removes submucosal fibroids through the cervix using a hysteroscope and does not require external incisions.

Before surgery, imaging studies such as ultrasound or MRI map fibroid location and size, and a medical history evaluates blood loss risk. During the procedure, the fibroids are cut out from the uterine wall with attention to hemostasis; the uterus is then repaired. Morcellation, the technique of fragmenting fibroids for removal, is less common today and may be avoided or done with contained systems due to concerns about spreading unsuspected cancer.

Recovery varies with the approach. Abdominal myomectomy usually requires several days in hospital and 4 to 8 weeks of recovery, while laparoscopic methods allow shorter stays and faster return to activity. Risks include bleeding, infection, injury to surrounding organs, scar formation, and, in future pregnancies, the potential for uterine rupture or recurrent fibroids.

Outcomes are favorable for women seeking to maintain fertility or avoid hysterectomy, with many achieving pregnancy after the procedure. Regular follow-ups assess healing and monitor for recurrence.