From the Guidelines
Laparoscopic or open myomectomy is the recommended procedure for the surgical removal of uterine fibroids, with the choice between the two depending on the size and number of fibroids, as well as the patient's overall health 1. The procedure involves removing the fibroids through abdominal incisions, and is indicated for subserosal or intramural fibroids.
- Key considerations for the procedure include:
- The size and number of fibroids, with open myomectomy preferred for multiple or very large fibroids
- The patient's overall health and fertility goals, as myomectomy can improve quality of life but may not guarantee fertility
- The potential risks and complications, including uterine rupture during subsequent pregnancy 1 Some important points to consider when deciding on a procedure include:
- Laparoscopic myomectomy is associated with shorter hospital stays and a faster return to usual activities compared to open myomectomy 1
- Robotic-assisted laparoscopic myomectomy is also an option, with outcomes similar to traditional laparoscopy 1
- Fertility outcomes are similar among hysteroscopic, laparoscopic, and open myomectomy, but less than half of patients trying to conceive achieve pregnancy after myomectomy 1
From the Research
Myomectomy Procedure
The procedure for myomectomy, or the surgical removal of uterine fibroids, can vary depending on the size, location, and number of fibroids, as well as the patient's overall health and desire for future fertility 2, 3.
Types of Myomectomy
There are several types of myomectomy, including:
- Open myomectomy: a traditional surgical approach where a single incision is made in the abdomen to access the uterus 4
- Laparoscopic myomectomy: a minimally invasive approach where several small incisions are made in the abdomen to insert a laparoscope and surgical instruments 4, 5
- Hysteroscopic myomectomy: a procedure where a hysteroscope is inserted through the vagina and cervix to remove submucous fibroids 5
- Robotic myomectomy: a minimally invasive approach that uses a robotic system to assist with the surgery 4
Considerations for Myomectomy
When considering myomectomy, the following factors should be taken into account:
- Fibroid size and location: larger fibroids or those located in certain areas of the uterus may require a different approach 3, 6
- Patient's desire for future fertility: myomectomy can be a good option for women who wish to retain their fertility 2, 4
- Overall health: patients with certain medical conditions or those who are older may be at higher risk for complications 3
- Alternative treatment options: other treatments, such as uterine artery embolization or magnetic resonance-guided focused ultrasound surgery, may be available and should be discussed with a healthcare provider 2, 6, 4, 5
Key Points to Consider
- Myomectomy can be an effective treatment for symptomatic fibroids, but it is not suitable for all patients 2, 3
- The choice of myomectomy approach depends on various factors, including fibroid size and location, patient's overall health, and desire for future fertility 3, 4
- Alternative treatment options should be discussed with a healthcare provider to determine the best course of treatment for each individual patient 2, 6, 4, 5