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Myomectomy

Overview

When a woman has fibroids that cause painful or uncomfortable symptoms, she may undergo myomectomy, a procedure to surgically remove them.

Fibroids are non-cancerous tumors that grow from the muscle tissue of the uterus. Many women with fibroids don’t experience symptoms and are unaware that they have these small, benign tumors. Others experience unpleasant symptoms, such as painful menstrual periods, heavier-than-usual blood flow during menstrual periods, and pelvic pain, to name a few.

When fibroid symptoms interfere with a woman’s quality of life, she may seek surgery—radiofrequency ablation, uterine artery embolization, hysterectomy, or myomectomy—to treat the condition. While many of these procedures are effective treatments for fibroids, they can affect a woman’s fertility. Radiofrequency ablation (RFA, also known as Acessa), for instance, may increase the risk of problems during vaginal delivery, and uterine artery embolization can increased risk for miscarriage and other problems during pregnancy. During a hysterectomy, doctors remove the entire uterus, meaning women who undergo this procedure can no longer become pregnant.

Myomectomy, however, typically preserves a woman’s fertility. In this procedure, doctors surgically remove individual fibroids from uterine muscle tissue while leaving the uterus in place. Many women who hope to become pregnant, as well as those who want to retain their uterus, are more likely to choose myomectomy over hysterectomy or other treatment options.

What is myomectomy?

Myomectomy is a surgical procedure used to remove fibroids from the uterine muscle without removing the uterus itself. Women who have a myomectomy are able to continue to have menstrual periods and become pregnant after the procedure. The procedure is reserved for women with moderate-to-severe pain, discomfort, and/or heavy bleeding caused by their fibroids.

Myomectomy is an alternative to hysterectomy, another surgical procedure used to treat fibroid pain and discomfort. Rather than removing fibroids from uterine tissue, however, hysterectomy removes the entire uterus, thereby eliminating the site where fibroids may grow. Because women who have a hysterectomy can no longer have their menstrual periods or become pregnant, women who wish to have children after treatment may opt for a myomectomy.

What condition is myomectomy used to treat?

Myomectomy is a treatment for fibroids, which are non-cancerous tumors that develop in the muscle walls of the uterus.

Some fibroids are tiny, and they may not cause symptoms. Others are large—about the size of a person’s fist—and can cause discomfort. Symptomatic fibroids may cause discomfort because they put pressure on the intestines and bladder, or they may cause painful periods and/or heavy bleeding.

Removing fibroids should help to alleviate the symptoms of pain, pressure, and heavy blood flow. Myomectomy allows doctors to remove symptomatic fibroids while sparing the uterus, so that a woman may continue to have menstrual periods and have the option of becoming pregnant.

How does myomectomy work?

During myomectomy, doctors remove fibroids from the uterine muscle tissue while the patient is under general anesthesia. Sometimes, women with larger fibroids will take medication before surgery to shrink them, making the fibroids easier to remove.

The type of myomectomy performed depends on the location and size of a woman’s fibroids. Surgical options include:

  • Open surgery. Typically, doctors make a transverse (left-to-right) incision in the lower abdomen to access the uterus, but sometimes a vertical (up and down incision) is used. The abdominal muscle walls are separated, and the uterus is gently removed from the abdominal cavity. Doctors may place a tourniquet on the portion of the uterus that doesn’t have fibroids, inject vasopressin—a drug that limits blood flow—or use other medications to reduce blood loss. In some cases, doctors may also place a temporary clamp or suture on blood vessels to limit blood loss. Once the fibroids are located, an incision is made in the uterine wall, through which one or more fibroids may be removed.
    
     After removal, doctors close the incision in the uterine wall with dissolvable stitches. If needed, they may make more than one incision to remove fibroids from different parts of the uterus.
    
    At the end of the procedure, dissolvable stitches are used to reconnect the abdominal muscle walls, and the surgical team may stitch, staple, or clamp the skin closed as well.
  • Laparoscopic surgery. During this minimally invasive procedure, doctors make small incisions in the abdomen, through which they thread their tools and a tiny camera with lights, so that they may view the uterus and fibroids. Once they locate fibroids with the camera, they make an incision in the uterine wall to surgically remove the fibroids. They may use vasopressin or sutures to stop the bleeding caused by fibroid removal. If the fibroid is too large to be removed through the small laparoscopic incisions, it may be sliced into smaller pieces. Once the fibroid has been removed, dissolvable stitches are used to close the incision in the uterine wall. The tools and camera are removed and the small abdominal incisions are stitched up. Sometimes, a laparoscopic procedure is performed robotically, which means that the surgeon uses a computer to direct tiny robotic arms within the body to make precise movements laparoscopically.
  • Hysteroscopic surgery. If a woman’s fibroids are located within the uterine cavity (instead of in the wall), doctors may approach the surgery through the vaginal opening, rather than through the abdominal wall. A tool called a hysteroscope, which has a tiny camera with lights on it, is threaded into the vagina, then into the cervix—the opening to the uterus. Saline solution may be used to expand the walls of the uterus, making it easier to find the fibroids.
    
    Once a fibroid is located on camera, doctors work to remove it. They may use a resectoscope—an instrument with a wire loop through which an electrical current passes—or another surgical instrument to cut the fibroid into small pieces, which are then removed using suction or other methods. After the procedure, the tools and camera are removed. No external stitches are required.
  • Vaginal surgery. In some cases, a fibroid may extend out of the cervix and into the vagina; when this occurs, the fibroid may be removed vaginally. Often, these fibroids are located at the end of stalks that bleed heavily when cut, so doctors may use sutures or a vasopressin injection to stop blood flow before slicing the fibroids free. The surgeon then cuts using scissors, another sharp instrument, or a wire loop with electrical current running through it. After the fibroid is removed, the wound may be cauterized (burned) to stop the bleeding. During vaginal surgery, doctors may use a hysteroscope to locate and remove fibroids. After the tools and camera are removed, no stitches are needed.

After each type of surgery, doctors visually examine the fibroids that were removed to check for abnormalities. They also send them to the pathology lab for review, although nearly all fibroids are non-cancerous; only 1 in 1,000 may be cancerous.

What are the risks associated with myomectomy?

There are risks associated with any surgery. The risks of myomectomy include:

  • Hemorrhage or blood loss
  • Infection at the surgical site
  • Weakened uterine walls, which may affect future pregnancies (a Cesarean section may be required, rather than vaginal childbirth)
  • Damage to neighboring body parts, such as the bladder or intestines
  • Blood clots
  • Negative reaction to anesthesia
  • Allergic reaction to medication
  • The development of scar tissue in the affected area
  • Possible infertility, caused by the presence of scar tissue or other complications
  • The formation of new fibroids

This article was medically reviewed by Terri Huynh, MD.