Laparoscopic/open myomectomy

Myomectomy is the removal of fibroids from the wall of the uterus through an abdominal route with open surgery or using a laparoscope. This is the preferred treatment for symptomatic fibroids in women who want to keep their uterus. It is an alternative to surgical removal of the whole uterus (hysterectomy).

This procedure is for fibroids that are subserosal (attached to the outside of the uterus) or in the wall of the uterus (intramural). Fibroids that are beneath the inner lining of the womb wall and grow into the endometrial cavity (submucosal) are easier to remove hysteroscopically.

During the operation a telescope (laparoscope) is inserted through a small (1cm) incision, usually in the navel (tummy button). Two or three additional small (0.5–1 cm) incisions are made for keyhole instruments to perform the surgery. The fibroids are detached from the uterus and removed, using a specially devised morcellator. Following removal of the uterine fibroids, the openings in the uterus are stitched closed. The procedure can take 1–2 hours, depending on the number, size and depth of the fibroids.

• Hysterectomy: There is a small risk that a hysterectomy (removal of womb) may be required during a myomectomy. This will only be performed if there is very heavy bleeding that cannot be stopped.
• Damage to bladder: This is very rare and would be repaired immediately if it happened. You would need to have a temporary catheter (a small plastic tube) fitted to drain the urine from your bladder to allow it to heal.
• Damage to the bowel: There is a very small risk of damage to the bowel as a result of a myomectomy. If this happens, the bowel will need to be repaired and you may need a temporary colostomy (an opening that drains into a bag on your abdomen to allow your bowel movement to pass into it while the damaged bowel is healing).
• Pain: Sometimes small nerves are cut or damaged during surgery. This may cause pain but it will usually improve over time as the nerves re-grow. Internal scar tissue (adhesions) may also cause pain following surgery, which may persist. These problems are rare and unpredictable, but you will be given painkillers to take home with you. Any pain usually improves over time.
• Recurrent fibroids: There is a risk of new fibroids growing within five years of surgery. This risk is very difficult to predict, but is higher in younger women.

Most women stay in hospital for three days after surgery. Usually, on the first morning after the operation the catheter is removed and the patient is able to eat, drink and move around.

The body will be using extra energy to build new cells and repair itself and patients may therefore feel tired for six weeks after surgery.

Recovery after surgery varies between individuals. Most women will resume driving and work six weeks after surgery.