A myomectomy is a surgical operation to remove one or a few fibroids. A myomectomy is offered to women who wish to retain both their uterus and fertility.
A myomectomy is possible for fibroids with suitable size and in suitable locations. Compared to a hysterectomy, a myomectomy is technically more demanding on the surgeon, takes longer to perform, and is more likely to require a blood transfusion. There is the risk that a myomectomy is sometimes converted to a hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus.
Development of adhesion (internal scarring of the abdomen) is a potential complication that can affect future fertility and pregnancy. Fibroids left behind may grow and cause symptom recurrence in 40 – 50% of women after a myomectomy.
A myomectomy can be performed through open incision, or via keyhole (laparoscopic or robotic). Though recovery is quicker with laparoscopic/robotic myomectomy, major surgical risks may not be lower. Laparoscopic/robotic surgery is technically more demanding, with a steeper learning curve for surgeons, due to limited access and visualisation. The major surgery risks still exist, in terms of injuries to blood vessels, the bowel, the bladder and the ureter. An open myomectomy takes longer to recover, due to the larger surgical incision. The access and visualisation of adjacent structures are better and uterine reconstruction can be easier.
Whether an open or laparoscopic/robotic myomectomy is the right choice for you depends on the reason for your myomectomy, your desire for a quick recovery, and the skill and the experience of your surgeon.
At Sydney Fibroid Clinic, a myomectomy is discussed as a preferred option for women who still desire future pregnancy. To enable us to provide you with more definitive opinion, we would require you to have an MRI of your uterus, performed by one of our preferred MRI service providers.