Introduction
Myomectomy is a surgical procedure performed to remove uterine fibroids (non-cancerous growths) while preserving the uterus. It is commonly recommended for women who experience symptoms such as heavy menstrual bleeding, pelvic pain, infertility, or pressure on nearby organs due to fibroids. Unlike hysterectomy, myomectomy allows women to maintain their reproductive ability and uterine function.
The procedure can be performed using different techniques depending on the size, number, and location of fibroids. Understanding the step-by-step process helps patients prepare for surgery and recovery.
Myomectomy Surgery Procedure
- Preoperative Preparation :- Before the surgery, the doctor conducts a detailed evaluation to understand the patient’s condition. This includes:
- Pelvic examination to assess uterine size and fibroid location
- Imaging tests such as ultrasound or MRI for accurate mapping of fibroids
- Blood tests to check hemoglobin levels, especially if heavy bleeding has caused anemia
- Review of medical history, medications, and allergies
In some cases, hormonal medications may be given before surgery to shrink fibroids and reduce bleeding during the procedure. Patients are usually advised to avoid eating or drinking for 6–8 hours before surgery.
- Anesthesia :- Myomectomy is performed under anesthesia to ensure a pain-free experience. Depending on the surgical approach, the patient may receive:
- General anesthesia (patient is fully asleep), or
- Spinal/epidural anesthesia (lower body is numbed)
The type of anesthesia is decided based on the surgical method and the patient’s overall health.
Types of Myomectomy Procedures
The surgical technique used depends on the fibroid’s size, number, and position.
- Hysteroscopic Myomectomy :- This method is used when fibroids are located inside the uterine cavity (submucosal fibroids). A thin instrument called a hysteroscope is inserted through the vagina and cervix into the uterus. No external cuts are required. The surgeon visualizes the fibroid and removes it using specialized instruments or electrical energy. This is a minimally invasive procedure with a quick recovery time.
- Laparoscopic (Minimally Invasive) Myomectomy :- This technique is suitable for small to moderate-sized fibroids located within or on the outer surface of the uterus. Small incisions are made in the abdomen. A laparoscope (a camera-equipped instrument) is inserted to view the uterus. Surgical tools are used to remove the fibroids. The uterine wall is repaired with stitches. This method results in less pain, minimal scarring, and faster recovery compared to open surgery.
- Open (Abdominal) Myomectomy :- Open surgery is recommended when fibroids are very large, numerous, or deeply embedded in the uterine wall. A larger incision is made in the lower abdomen (similar to a cesarean section). The uterus is accessed directly. Fibroids are carefully removed. The uterine muscle is reconstructed and stitched to maintain strength. Although recovery takes longer, this approach allows complete removal of complex fibroids.
Removal and Repair
During all types of myomectomy, the surgeon ensures:
- Complete removal of fibroids
- Control of bleeding
- Careful repair of the uterine muscle
- Preservation of healthy uterine tissue
In some cases, special techniques are used to minimize blood loss and maintain uterine strength for future pregnancies.
Duration of the Surgery
The surgery usually takes 1 to 3 hours, depending on:
- Number of fibroids
- Size and location
- Type of surgical approach
After the procedure, the patient is moved to a recovery room for monitoring.
Postoperative Care
Recovery varies depending on the type of myomectomy.
Hospital stay:
- Hysteroscopic: Same-day discharge
- Laparoscopic: 1–2 days
- Open surgery: 2–4 days
Initial care includes:
- Pain management with medications
- Monitoring for bleeding or infection
- Early walking to prevent blood clots
- Avoiding heavy lifting or strenuous activity
Patients are advised to avoid sexual intercourse and strenuous exercise for a few weeks, as recommended by the doctor.
Fertility and Future Pregnancy
Myomectomy improves fertility in many women. However, doctors may recommend waiting 3–6 months before attempting pregnancy to allow the uterus to heal completely. In some cases, a cesarean delivery may be advised for future pregnancies, especially after deep uterine repair.
Conclusion
Myomectomy is an effective surgical procedure for removing fibroids while preserving the uterus and fertility. Depending on the size and location of fibroids, the surgery may be performed hysteroscopically, laparoscopically, or through open abdominal surgery. With proper surgical technique and postoperative care, most women experience relief from symptoms such as heavy bleeding and pelvic pain, along with improved reproductive outcomes. Consulting an experienced gynecologist and following the recommended recovery plan ensures safe healing and long-term benefits.
