Types of Myomectomy Surgery

Jul 25, 2025
Author: Medisuggest

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in or on the uterus. While many women with fibroids experience no symptoms, others may suffer from heavy bleeding, pelvic pain, frequent urination, and infertility. Myomectomy is a surgical procedure designed to remove fibroids while preserving the uterus, making it an ideal option for women who wish to maintain their fertility.

Understanding of the Types of Myomectomy Surgery is essential in choosing the best treatment approach.

Myomectomy is a specialized surgical procedure focused on removing fibroids from the uterus without affecting the healthy uterine tissue. Unlike a hysterectomy, which removes the uterus entirely, myomectomy allows women to retain their uterus and the possibility of future pregnancies. It is often recommended for women of reproductive age or for those who prefer to avoid complete uterine removal.

The choice of surgical method depends on several factors, including the size, number, and location of fibroids, as well as the patient’s overall health and future pregnancy plans. The three primary types of myomectomy surgeries include abdominal myomectomy, laparoscopic myomectomy, and hysteroscopic myomectomy.

Types of Myomectomy Surgery

  1. Abdominal Myomectomy (Open Myomectomy) :- Abdominal myomectomy is the traditional approach to fibroid removal. In this method, the surgeon makes a horizontal or vertical incision through the lower abdomen to access the uterus and remove the fibroids.When Is It Used? : This method is typically recommended when:
    • Fibroids are large or numerous
    • Fibroids are deeply embedded within the uterine wall
    • Other less invasive options are not viable

    Procedure Overview :- Under general anesthesia, the surgeon opens the abdominal cavity and carefully excises the fibroids. The uterus is then repaired with sutures. Since this is a major surgery, it usually requires hospitalization for up to three days and a recovery period of approximately six to eight weeks.
    Pros and Cons :- Advantages:

    • Can remove large or multiple fibroids
    • Allows thorough access to the uterus

    Disadvantages:

    • Longer hospital stay and recovery
    • Higher risk of postoperative complications such as infection or blood loss
  2. Laparoscopic Myomectomy (Minimally Invasive Surgery)

    Laparoscopic myomectomy is a less invasive alternative to open surgery. It involves making small incisions in the abdomen through which a laparoscope and surgical instruments are inserted to remove the fibroids.

    When Is It Used?

    • Laparoscopic myomectomy is suitable when:
    • Fibroids are moderate in size
    • Fibroids are fewer in number and easily accessible
    • Patient desires a quicker recovery

    Procedure Overview :- This surgery is performed under general anesthesia. The abdomen is inflated with carbon dioxide to provide working space. The surgeon uses a camera-equipped laparoscope to view the uterus and remove the fibroids. In some cases, robotic assistance may be used for better precision.

    The removed fibroids may be extracted in small pieces using a technique called morcellation, although this practice is now more regulated due to potential risks in rare cases involving undiagnosed cancerous tissues.

    Pros and Cons :- Advantages:

    • Minimal scarring and less postoperative pain
    • Shorter hospital stay and faster recovery (typically 2 to 4 weeks)
    • Reduced blood loss

    Disadvantages:

    • Not suitable for large or deeply embedded fibroids
    • May not allow for removal of all fibroids if spread across multiple uterine layers
  3. Hysteroscopic Myomectomy (Non-Invasive Approach) :- Hysteroscopic myomectomy is the least invasive technique, performed through the vagina and cervix without any external incisions. It is ideal for removing submucosal fibroids, which grow into the uterine cavity.
    • When Is It Used?
    • Hysteroscopic myomectomy is recommended when:
    • Fibroids are small and located within the uterine cavity
    • The patient has symptoms like abnormal uterine bleeding or infertility
    • Minimal downtime is preferred

    Procedure Overview :- This procedure involves inserting a hysteroscope into the uterus via the vagina. Using specialized instruments, the surgeon shaves off or cuts out the fibroid tissue. The entire procedure is generally done in an outpatient setting and requires little to no hospital stay.

    Pros and Cons :- Advantages

    • No abdominal incisions
    • Quick recovery (few days to one week)
    • Can often be performed without general anesthesia

    Disadvantages:

    • Only suitable for certain fibroid types
    • Cannot treat fibroids located deep in the uterine wall or outside the cavity
    • May require repeat procedures if fibroids regrow

Choosing the Right Myomectomy Type

Selecting the right myomectomy approach involves a collaborative decision between the patient and her healthcare provider. Factors influencing this decision include:

  • Number and location of fibroids

  • Severity of symptoms

  • Desire for future pregnancies

  • Age and overall health

  • Access to specialized surgical techniques or equipment

Diagnostic tools like pelvic ultrasound, MRI, or hysterosonography help map fibroid positions and determine the best surgical route.

Recovery and Postoperative Care

Recovery varies depending on the type of myomectomy performed. Abdominal myomectomy generally requires a longer rest period, while laparoscopic and hysteroscopic approaches allow for a quicker return to normal activities.

Common postoperative recommendations include:

  • Limiting physical activity and avoiding heavy lifting

  • Managing pain with prescribed medications

  • Monitoring for signs of infection or bleeding

  • Attending follow-up appointments to assess healing

In cases where future pregnancy is desired, doctors may recommend waiting several months before attempting conception to ensure proper uterine healing.

Conclusion

Myomectomy is a valuable surgical option for women seeking relief from fibroid-related symptoms while preserving their fertility. Understanding the different types of myomectomy surgeries helps patients make informed choices about their treatment options.

Abdominal, laparoscopic, and hysteroscopic myomectomy each offer distinct advantages and are tailored to specific medical scenarios. A thorough evaluation by a qualified gynecologist ensures the most suitable and effective approach is chosen, leading to better outcomes and improved quality of life.

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