Myomectomy Procedure - Healthnile.com

Overview

Surgeons perform a myomectomy to remove fibroids—also known as myomas or leiomyomas—from the uterus. These fibroids are noncancerous growths that can develop inside or on the wall of the uterus, often during the childbearing years. The main purpose of this surgery is to remove the growths causing symptoms while keeping the uterus in place.

Key Points:

Only fibroids are removed, not the entire uterus.
Often performed to help reduce heavy bleeding or pelvic discomfort.
The endometrium (lining of the uterus) is preserved.
Women who wish to maintain fertility may benefit.

Many people experience relief from symptoms linked to uterine fibroids after the procedure.

Reasons for Choosing This Surgery

Doctors recommend a myomectomy when fibroids cause symptoms such as pelvic pain, backache, constipation, heavy bleeding, or pelvic pressure. It may be chosen to:

Remove fibroids without taking out the uterus.
Preserve the chance to have children.
Manage infertility possibly caused by fibroids.

Unlike a hysterectomy, this option helps maintain reproductive potential.

Possible Problems and Negative Effects

Myomectomy can help treat uterine fibroids, but like all surgeries, it has some risks. Common issues after surgery include excessive bleeding, infection, pain, and problems with stitches, urination, or scars. Very rarely, someone may need a blood transfusion or develop scar tissue inside the body.

Main Risks After Myomectomy

Risk	Description	How Common
Excessive bleeding and blood loss	Heavy bleeding may happen, requiring a blood transfusion in some cases.	Sometimes
Infection	The surgical area can become infected after the operation.	Rare
Pain and soreness	Most people feel pain and cramping, especially in the first days.	Common
Scar tissue (Adhesions)	Bands of scar tissue may form in the pelvis or uterus after surgery.	Sometimes
Problems with stitches	Stitches may feel uncomfortable or pull, and sometimes need extra care.	Uncommon
Urination issues	The bladder or nearby organs may be affected, making urination harder.	Rare
Incision site problems	Scarring may occur on the skin or inside the body.	Sometimes
Need for blood transfusion	A transfusion may be required if bleeding is high.	Rare
Rare need for hysterectomy	Removing the uterus is very rare but can happen if bleeding cannot stop.	Very rare
Cancer spread (with morcellation)	Rare risk if a cancer is mistaken for a fibroid and spreads inside the abdomen.	Very rare

Other Possible Effects

Spotting or vaginal bleeding can continue for some time after the procedure.
Discomfort with bowel movements may happen due to swelling or stitches.
Delay in normal activities may follow if healing is slow or further treatment is needed.

Ways to Lower the Chance of Problems After Surgery

Doctors use several steps to avoid or lower possible negative effects during and after myomectomy. Focusing on these areas can improve the patient’s recovery and safety.

1. Improving Blood Levels Before Surgery

Iron Supplements and Vitamins: Patients with low iron due to heavy monthly bleeding can take iron tablets and extra vitamins. Raising blood levels before an operation may reduce the need for a blood transfusion.
Careful Planning: Blood tests before surgery show if a patient needs extra support.

2. Hormone Therapy

Gonadotropin-Releasing Hormone (GnRH) Agonists: Doctors may suggest medicines that stop the menstrual cycle and lower hormone levels, building up the body’s iron stores before surgery. These medications can also shrink fibroids, making the operation safer and easier.
Other Hormone Medicines: Birth control pills or different hormone drugs may also help lower blood loss during surgery.

3. Shrinking Fibroids Before Surgery

Medications like GnRH agonists or selective progesterone receptor modulators (SPRMs) can make fibroids smaller.
Benefits: Smaller fibroids are easier to remove, and there may be less bleeding. Sometimes, these treatments lower bleeding enough that surgery is not needed.
Possible Symptoms: Some medicines can cause hot flashes, sweating at night, and dryness. These side effects usually go away after stopping the medication.

4. Surgical Steps to Control Bleeding

Surgeons use tools and medicines to limit blood flow to the uterus during surgery, lowering the amount of blood lost.
- Examples: Tourniquets, clamps, or shots near the fibroid to tighten blood vessels.

5. Surgical Methods with Less Damage

Minimally-Invasive Surgery: Laparoscopic methods or small cuts often cause less damage and fewer scars than larger open surgery.
Less scarring also means a lower chance of blockage or pain from adhesions inside.

6. Careful Use of Special Devices

For some patients, doctors avoid certain devices (like power morcellators) that could spread hidden cancers, especially in older women or after menopause.
Patients should talk with their doctors about the safest ways to remove fibroids and avoid unexpected risks.

Summary Table: How Doctors Lower Surgical Risk

Method	What It Helps Prevent
Iron/vitamins	Anemia and blood transfusion
Hormone therapy (GnRH, others)	Severe bleeding, large fibroids
Medicines to shrink fibroids	Blood loss, surgical complications
Tourniquets/clamps/injections	Blood loss during surgery
Laparoscopic/minimally invasive	Large scars, painful adhesions

Patients can help themselves recover by following their doctor’s advice. This includes watching for signs of infection, keeping the wound clean, and reporting any severe pain, fever, or other unusual symptoms. Staying alert to these details may prevent or limit complications from surgery.

How You Get Ready

Eating, Drinking, and Medicine

Doctors require fasting before surgery. Most people must stop eating and drinking for several hours ahead of time. Always follow the exact hours given by the doctor. Patients should check with their doctor about any medication changes before surgery.

This includes all prescription drugs, over-the-counter pills, vitamins, and supplements. Some items, such as blood thinners or herbal products, might need to be paused for safety. Types of anesthesia to expect include:

Type	Description	Common Use
General anesthesia	Patient is fully asleep, tube down the throat	Laparoscopic & abdominal types
Monitored anesthesia	Patient feels asleep, but no throat tube	Usually for hysteroscopic type
Other types	May include local or spinal anesthesia	Rare cases

Doctors will also share pain medicine plans before the procedure. Patients should know which pain medications they might get and how these will be given during recovery.

Additional Steps Before the Procedure

The type of fibroid surgery affects how long someone will stay in the hospital. Most people need to bring someone with them the day of the operation.

Abdominal surgery (laparotomy) often means staying in the hospital for one to two nights.
Laparoscopic or robotic surgery is usually outpatient, or sometimes just one night.
Hysteroscopic surgery often allows patients to go home the same day.

Patients should arrange for a friend or family member to provide transportation, since it is not safe to drive afterward. Discuss any questions about sexual activity and how soon it can be resumed after surgery with the healthcare team.

Tip: Do not use lotions, perfumes, or deodorants on surgery day. Avoid shaving near the surgery area to lower risks of infection.

What You Can Expect

Open Abdominal Surgery for Fibroid Removal

For this surgery, the surgeon makes a cut on the lower belly to reach the uterus and take out the fibroids. Most of the time, the incision is horizontal, just above the pubic area (bikini line), but for larger uteruses, a vertical cut may be needed. This is called open myomectomy or an abdominal myomectomy.

Type of Incision

Horizontal (bikini line) for most cases.
Vertical when more space is needed.

Patients may stay in the hospital for a few days after this surgery. Recovery can take several weeks. Because this approach is more invasive, patients usually experience more pain, a longer healing time, and a bigger scar than with minimally invasive surgery.

Minimally Invasive Myomectomy Methods

Surgeons can use two main methods that require small incisions: laparoscopic and robotic myomectomy. Both kinds are known as minimally invasive surgeries.

Process

Surgeons make several small cuts in the abdomen.
A thin tool with a camera (laparoscope) goes through one incision.
Surgeons use special surgical instruments through the other cuts.

Differences between laparoscopic and robotic procedures:

Method	Who controls tools	Special equipment	Time in surgery
Laparoscopic	Surgeon	Laparoscope (camera)	Usually shorter
Robotic	Surgeon at console	Robotic arms	May take longer

In both approaches, surgeons may cut some fibroids into smaller pieces so they can be taken out through the tiny incisions. Sometimes, a single small entry point is used. Most patients go home the same day or after one night. Recovery is usually faster, and there is less blood loss and fewer problems with adhesions.

Fibroid Removal by Going Through the Vagina and Cervix

Doctors use this method for smaller fibroids inside the uterus. No abdominal incisions are needed. Instead, instruments go in through the vagina and cervix. The doctor fills the uterus with a clear liquid to stretch it and see better.

The doctor inserts a lighted tool into the uterus.
The doctor shaves away the fibroid using either a loop with electricity or a blade.
The doctor removes small pieces until the fibroid is gone.

Bigger fibroids might need more than one surgery to take out fully. This approach is called hysteroscopic myomectomy and is less invasive, so recovery is usually quick.

What Happens After Surgery

Right after the procedure, doctors give most patients prescriptions for pain medicine and directions on how to care for themselves at home. Doctors also discuss any limits on activity or food. It’s normal to have some light bleeding or spotting for a few days, sometimes up to six weeks.

The amount and length of bleeding depends on which type of myomectomy doctors performed. Most people are advised to avoid heavy lifting, sports, and sexual activity until cleared by the doctor. Follow-up visits are set to check healing and talk about any concerns.

Outcomes

Many people who have a myomectomy report fewer symptoms, such as lighter periods and less pelvic pain. Relief from heavy bleeding and pressure commonly occurs soon after the procedure, with most patients noticing improvements within the first few months.

Surgery often improves fertility, especially for those who undergo the procedure using a laparoscopic method. Doctors generally advise waiting about three to six months before trying to get pregnant to give the uterus time to heal. Studies show that many women become pregnant within a year after the operation.

Fibroids can come back in the future. The chance is lower in people who had only one fibroid removed or who become pregnant after the myomectomy. If fibroids return or new ones grow, doctors can offer different treatment options, including non-surgical methods. Possible ongoing treatments for recurring fibroids include:

Treatment Type	How It Works
Uterine artery embolization (UAE)	Limits blood flow to the fibroids.
Radiofrequency ablation (RVTA)	Destroys fibroid tissue using heat.
MRI-guided focused ultrasound (MRgFUS)	Ablate fibroids guided by MRI.

If a patient no longer wants to have children and fibroids return, a hysterectomy is an option.