What you can expect
Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approaches to myomectomy.
In abdominal myomectomy (laparotomy), your surgeon makes an open abdominal incision to access your uterus and remove fibroids. Your surgeon will generally prefer to make a low, horizontal ("bikini line") incision, if possible. Vertical incisions are needed for larger uteruses.
Laparoscopic or robotic myomectomy
In laparoscopic or robotic myomectomy, both minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions.
Compared with women who have a laparotomy, women who undergo laparoscopy have less blood loss, shorter hospital stays and recovery, and lower rates of complications and adhesion formation after surgery. There are limited comparisons between laparoscopic and robotic myomectomy. Robotic surgery may take longer and be more costly, but otherwise few differences in outcomes are reported.
- Laparoscopic myomectomy. Your surgeon makes a small incision in or near your bellybutton. Then he or she inserts a laparoscope — a narrow tube fitted with a camera — into your abdomen. Your surgeon performs the surgery with instruments inserted through other small incisions in your abdominal wall.
- Robotic myomectomy. Your surgeon inserts instruments through small incisions similar to those in a laparoscopic myomectomy, and then controls movement of the instruments from a separate console. Some surgeons are now performing single-port (one incision) laparoscopic and robotic myomectomies.
Sometimes, the fibroid is cut into pieces (morcellation) and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so that it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).
To treat smaller fibroids that bulge significantly into your uterus (submucosal fibroids), your surgeon may suggest a hysteroscopic myomectomy. Your surgeon accesses and removes the fibroids using instruments inserted through your vagina and cervix into your uterus.
A hysteroscopic myomectomy generally follows this process:
- Your surgeon inserts a small, lighted instrument through your vagina and cervix and into your uterus. He or she will most commonly use either a wire loop resectoscope to cut (resect) tissue using electricity or a hysteroscopic morcellator to manually cut the fibroid with a blade.
- A clear liquid, usually a sterile salt solution, is inserted into your uterus to expand your uterine cavity and allow examination of the uterine walls.
- Your surgeon shaves pieces from the fibroid using the resectoscope or the hysteroscopic morcellator, taking out the pieces from the uterus until the fibroid is completely removed. Sometimes large fibroids can't be fully removed in one surgery, and a second surgery is needed.
After the procedure
At discharge from the hospital, your doctor prescribes oral pain medication, tells you how to care for yourself, and discusses restrictions on your diet and activities. You can expect some vaginal spotting or staining for a few days up to six weeks, depending on the type of procedure you've had.