Myomectomy is a procedure in which uterine fibroids (also known as myomas) are surgically removed from the uterus (womb). Fibroids can cause heavy and persistent uterine bleeding, pressure feeling, pain and in certain cases infertility. Women who wish to have children or simply do not want to lose their uterus (hysterectomy) look for conservative treatments. Myomectomy can be performed using different surgical approaches.
Abdominal myomectomy: removal of fibroids through an incision in the abdomen. The incision is usually horizontal (bikini line), although in cases of very large fibroids a midline incision may be required. There is no limit to the size or number of fibroids that can be removed. The disadvantage of abdominal myomectomy is that it requires an incision in the abdomen, so recovery is longer than required if an incision is avoided.
Laparoscopic myomectomy: removal of fibroids through keyhole surgery. Fibroids that are located on the outside of the uterus (subserous fibroids), those located in the muscular layer of the uterus (intramural fibroids) and those which are attached to the uterus by a stalk (peduncolated fibroids) are easy to remove laparoscopically. Fibroids located deep in the wall of the uterus in contact with the endometrium (submucous fibroids) are better removed by hysteroscopy. The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that 3 or 4 small incisions (0.5-1 cm each) are used rather than one larger incision. If there is a large number of fibroids (generally more than 5) and if the larger fibroids measures more than 10cm, an abdominal myomectomy is a much better option in terms of repairing the uterus.
Hysteroscopic myomectomy (hysteroscopic resection of myomas): removal of fibroids through the cervix using a special hysteroscope called resectoscope. This instrument uses high-frequency electrical energy to cut or coagulate tissue. Only fibroids located in the inner part of the uterus (submucous fibroids) and intracavitary fibroids (bulging inside the uterine cavity) can be removed using this technique. No skin incision is necessary. The complications of myomectomy include bleeding, organs injury, blood vessels and nerve injuries, infection and blood clot formation. The risk of hysterectomy following myomectomy is of 1%.