Myomectomy

Surgery Overview

Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. Myomectomy is the preferred fibroid treatment for women who want to become pregnant. After myomectomy, your chances of pregnancy may be improved but are not guaranteed.

Before myomectomy, shrinking fibroids with gonadotropin-releasing hormone analogue (GnRH-a) therapy may reduce blood loss from the surgery. GnRH-a therapy lowers the amount of estrogen your body makes. If you have bleeding from a fibroid, GnRH-a therapy can also improve anemia before surgery by stopping uterine bleeding for several months.

Surgical methods for myomectomy include:

• Hysteroscopy, which involves inserting a lighted viewing instrument through the vagina and into the uterus.
• Laparoscopy, which uses a lighted viewing instrument and one or more small cuts (incisions) in the abdomen.
• Laparotomy, which uses a larger incision in the abdomen.

The method used depends on the:

• Size, location, and number of fibroids.
  • Hysteroscopy can be used to remove fibroids on the inner wall of the uterus that have not grown deep into the uterine wall.
  • Laparoscopy is usually reserved for removing one or two fibroids, up to about 2 in. (5.1 cm) across, that are growing on the outside of the uterus.
  • Laparotomy is used to remove large fibroids, many fibroids, or fibroids that have grown deep into the uterine wall.
• Need to correct urinary or bowel problems. To repair these problems without causing organ damage, laparotomy is usually needed.