Myomectomy (Fertility-Sparing Fibroid Surgery)
Laparoscopic/robotic, abdominal (open), or hysteroscopic removal of fibroids—matched to your anatomy, symptoms, and pregnancy goals.
Myomectomy removes fibroids (leiomyomas) and reconstructs the uterus to preserve function. We offer laparoscopic/robotic, abdominal (open), and hysteroscopic approaches depending on fibroid size, number, and location. Goals include lighter periods, less pressure/bulk symptoms, relief of pain, and improved fertility/implantation when the uterine cavity is distorted.
Fast Facts About Myomectomy
Uterus-preserving surgery; suitable when future pregnancy is desired
Approach is tailored: laparoscopic/robotic, abdominal (open), or hysteroscopic
Tissues are sent to pathology; most fibroids are benign
Recovery varies by approach—from days (minimally invasive) to weeks (open)
Recurrence is possible; ongoing follow-up is recommended
Who It May Help
- Heavy menstrual bleeding, clotting, or anemia from fibroids
- Pelvic pressure, urinary frequency, constipation, or visible abdominal distension
- Infertility or recurrent pregnancy loss with cavity distortion
- Rapidly enlarging or symptomatic fibroids unresponsive to medication
- Desire to preserve the uterus and fertility options
How It Works
Fibroids are mapped with ultrasound and/or MRI to plan incisions and repair. During surgery we incise the uterus over each fibroid, shell it out, control bleeding, and close the uterine wall in layered sutures to restore strength and shape. Minimally invasive cases use small ports and specialized instruments; open cases use a lower abdominal incision for larger or numerous fibroids. Submucosal (cavity-protruding) fibroids can often be removed hysteroscopically through the cervix with no abdominal incisions.
Candidacy & Alternatives
Good candidates have symptomatic fibroids or fertility goals that benefit from removal. Alternatives include medical therapy (e.g., LNG-IUD, combined hormonal options, GnRH analogs/antagonists), uterine artery embolization (UAE) for bleeding/bulk relief (often not first-line when future pregnancy is prioritized), MRI-guided focused ultrasound in select cases, or hysterectomy for definitive treatment when childbearing is complete. We individualize based on size, number, location, age, and reproductive plans.
Choosing the Surgical Approach
Laparoscopic/Robotic Myomectomy
- Small incisions; faster recovery (often 1–2 weeks to routine activity)
- Best for moderate size/number with favorable locations
- Typically less blood loss and shorter hospital stay
- May require tissue containment for specimen removal
Abdominal (Open) Myomectomy
- Lower abdominal incision; longer recovery (often 4–6 weeks)
- Useful for very large, numerous, or deeply embedded fibroids
- Allows extensive reconstruction and palpation
- Inpatient stay is more common
Hysteroscopic Myomectomy
- Through the cervix; no abdominal incisions
- For submucosal fibroids (FIGO 0–2) that distort the cavity
- Quick recovery; may require staged procedures for deep lesions
- Does not treat intramural or subserosal fibroids
What to Expect
Most minimally invasive cases are outpatient; open surgery may require a short hospital stay. Expect cramping and abdominal soreness that improve over days to weeks depending on approach. Light spotting can occur if a uterine manipulator is used. We’ll review activity limits, incision care, and timing for return to exercise/intercourse. If the uterine wall is extensively reconstructed, we may recommend cesarean delivery in future pregnancies; we’ll document this in your operative note.
Safety & Considerations
Typical effects include pain, fatigue, and transient bloating. Uncommon risks: bleeding or transfusion, infection, injury to nearby organs, adhesions, venous thrombosis, or need to convert to open surgery. Recurrence or growth of new fibroids is possible. Rarely, pathology reveals unexpected sarcoma; pre-op imaging and risk assessment help guide planning. For fertility, we balance thorough removal with preservation of healthy myometrium and careful layered closure.
Before Your Visit
- ✓Share recent ultrasound/MRI and hemoglobin/iron studies
- ✓Ask about pre-op medications (e.g., iron, GnRH analog/antagonist) to optimize surgery
- ✓Discuss family-building timeline and delivery planning after uterine repair
- ✓Follow anesthesia fasting and medication instructions; arrange a ride home
- ✓Plan time off: days for minimally invasive; weeks for open surgery
Frequently Asked Questions
1Will myomectomy improve fertility?
When fibroids distort the uterine cavity or significantly alter uterine shape, removing them can improve implantation and pregnancy rates. Benefits depend on your overall fertility picture and fibroid characteristics.
2How long is recovery?
Most laparoscopic/robotic patients resume light activity in a few days and regular activity in ~1–2 weeks. Open myomectomy generally requires 4–6 weeks for full recovery.
3Can fibroids come back after surgery?
New fibroids can develop and existing small fibroids can grow. Recurrence risk varies with age, number of fibroids, and biology; we’ll plan follow-up and prevention strategies.
4Will I need a C-section after myomectomy?
It depends on the depth and number of uterine incisions. After significant myometrial reconstruction, many clinicians recommend cesarean delivery to reduce the risk of uterine rupture in labor.
5Are there non-surgical options?
Yes—LNG-IUD, combined hormonal methods, tranexamic acid, GnRH analogs/antagonists, and UAE can help symptoms. Choice depends on your goals, fibroid features, and desire for future pregnancy.
6Could my fibroid be cancer?
Uterine sarcoma is rare. We assess risk with history and imaging; all removed tissue is sent to pathology to confirm diagnosis.
Considering Fibroid Removal While Preserving Your Uterus?
We’ll map your fibroids, choose the safest approach, and plan a recovery pathway aligned with symptom relief and fertility goals.
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