A myomectomy is the surgical removal of fibroids in the uterus. This treatment is recommended for women who want to become pregnant. There are different types of myomectomy procedures, including:
- Hysteroscopic Myomectomy
In this procedure a long, thin scope with a camera and light is passed through the vagina and cervix into the uterus. No incision is needed. Submucosal or intracavitary fibroids can be resected or removed using a wire loop or similar device. Patients are usually sent home following the procedure. The hospital stay is generally under two hours, and recovery time is one or two days. Usually only small fibroids accessible through the cavity can be treated this way.
- Laparoscopic Myomectomy
The laparoscope is a slender telescope inserted through the navel (belly button) to view the pelvic and abdominal organs. Two or three half-inch incisions are made below the pubic hairline and instruments are passed through these incisions to perform the surgery. Next, a small scissors-like instrument is used to open the thin covering of the uterus, where the fibroid is found and removed. After the fibroid is removed from the uterus, it is brought out of the abdominal cavity. This is done by cutting the fibroid into small pieces. The pieces are then removed through one of the incisions. Most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be required. Patients can usually walk on the day of surgery, drive in about a week, and return to normal activity within two weeks.
- Robotic-assisted Myomectomy
During this procedure, a surgeon sits at a special console with hand and foot controls that move robotic arms during the operation. With the assistance of the robot, the surgeon injects medication into the fibroids to decrease overall bleeding and makes an incision in the uterus. The surgeon then removes the fibroid(s) from the surrounding uterine tissue. Once the fibroid has been removed, the surgeon cuts the fibroid into smaller pieces inside the abdomen, and removes the fibroid pieces through the incision. Patients typically go home the same day of the procedure and most patients resume normal activities within two weeks.
- Abdominal Myomectomy
The operation begins with a surgeon entering the pelvic cavity through one or two incisions. Depending on the size and location of the fibroid, a vertical or horizontal incision is made. For large fibroids or fibroids that are located in a ligament between the uterus and pelvic wall, a vertical incision is required. The incision is made from the middle of the abdomen that extends below the navel (belly button). In other cases, a horizontal bikini-line incision is made that runs about an inch above the pubic bone. The procedure usually requires a hospital stay of two to three days. Recovery takes four to six weeks.