Myomectomy

A surgical procedure to remove just the fibroid, called a myomectomy, can be performed on those wishing to preserve their fertility. About 34,000 myomectomies are performed yearly in the United States. Most myomectomies are performed through an abdominal incision into the uterus, although certain submucosal fibroids can be removed through the vagina without an abdominal incision using a procedure called hysteroscopic myomectomy. This technique is performed by gently dilating the cervix and inserting a hysteroscope into the uterus. The fibroid is then shaved away by the surgeon, typically using an electrified wire loop. The small fibroid pieces are removed through the dilated cervix. It is primarily useful for pregnant women with bleeding or other problems related to the fibroids since it preserves the size of the uterus.

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Certain fibroids may be removed through a small bellybutton incision in a laparoscopic myomectomy. A camera is inserted through a 5-10mm incision in the bellybutton and two or three additional incisions are made on the abdomen to allow for long laparoscopic instruments to be inserted and used. The fibroid is grasped and freed, and cut into small pieces so that it can be removed. The incision on the uterus is then sutured in the traditional fashion, using the long laparoscopic instruments.

In general, myomectomy diminishes bleeding in approximately 80 percent of patients presenting with this symptom. But there is a significant risk of recurrence of fibroids after myomectomy; in some studies about 25 to 50 percent of women who had myomectomies wound up with a recurrence of fibroids within 10 years, and up to 10 percent required a second surgery.