A myomectomy is a surgical procedure to remove uterine fibroids, noncancerous tumors, without removing the uterus. 

Depending on the location of the fibroids, the myomectomy can be done through the pelvic area or through the vagina and cervix. 

Removing fibroids may enable a woman to get pregnant after the surgery.

A woman may choose to undergo a myomectomy to remove her uterine fibroids if she is experiencing aggravating symptoms from those fibroids, and she would like to retain her uterus for personal or reproductive reasons.

Depending on the location and size of a woman’s fibroids, these growths can interfere with conception, prevent implantation of a fertilized egg, or obstruct the fallopian tubes, preventing the embryo from passing into the uterine cavity and implanting on the endometrial lining. 

Fibroids can also cause problems during pregnancy, including affecting the blood flow and preventing the fetus from growing properly and causing pre-term labor and birth. 

To prevent these problems, women with fibroids who want to become pregnant should consider a myomectomy to remove the fibroids. In many cases, infertility specialists will refer patients for this surgery before attempting in vitro fertilization (IVF).

Depending on the size, number and location of your fibroids, physicians use different surgical approaches such as open abdominal surgery or minimally invasive laparoscopic surgery.

• Open myomectomy – the most commonly performed surgery – is often not the best solution. It requires either making a horizontal incision above the pubic bone or a vertical incision from just below the navel to the pubic bone. The benefit of open procedures is all fibroids can be removed from all locations, and the uterus can be properly closed to heal prior to attempting to conceive a child. However, a major disadvantage is a much larger incision, resulting in more pain and longer recovery times of 6 to 8 weeks. There is a much higher rate of complications as well.

• Laparoscopic or robotic myomectomies are minimally invasive procedures that can remove fibroids on stalks or from the outside the uterus without too much difficulty, when performed by a well-trained laparoscopic surgeon. However, these procedures present challenges when the fibroids are very large or there are large numbers of fibroids in the uterus. Other disadvantages include the time involved in performing these surgeries, the potential for heavy bleeding and the potential that all the fibroids will not be removed. There is also the risk that the uterus will not heal properly due to lack of access to incisions for effective repair. 

Additional Disadvantage: During some laparoscopic procedures, surgeons may choose to use a power morcellator, a device used to divide up and remove large masses during laparoscopic procedures. The Food and Drug Administration (FDA) now requires surgeons to tell patients if they will use this device because of the potential for morcellators to spread cells of a hidden uterine cancer called sarcoma through the abdomen and pelvis during surgery.

• LAAM-BUAO, an innovative GYN surgical technique, was invented by the surgeons at The Center for Innovative GYN Care to overcome the challenges and disadvantages of other myomectomy surgeries. LAAM takes the best elements of both laparoscopic and open approaches for fibroid removal. LAAM (Laparoscopic Assisted Abdominal Myomectomy) entails two small incisions, one at the belly button and one at the bikini line.  It is specifically designed for women who are seeking fertility. Women who are past childbearing may not be candidates for LAAM.  
  • BENEFITS OF LAAM: LAAM is not limited by fibroid size, number, or location. BUAO (Bilateral Uterine Artery Occlusion) is used to control bleeding during the procedure so the surgery is efficient with minimal blood loss. Due to the advantage of the surgeon being able to feel all of the fibroids, LAAM is the most thorough minimally invasive technique used for a myomectomy. Most LAAM procedures are done in an outpatient setting, and patients are able to return to their lives sooner than with open procedures.
  • LAAM-BUAO is a more convenient surgery. Generally, the procedure takes approximately one hour and can be performed as an outpatient procedure, with shorter recovery times and less complication.  By comparison, standard open procedures are up to four hours and require a hospital stay.

Myomectomy Techniques and Fibroid Location  

(Note, open procedures can remove all fibroids, but pain and recovery time are increased.)  Learn more about fibroids and where they can be located.

Myomectomy Techniques and Fibroid Size

Myomectomy Techniques and Number of Fibroids

Like any surgical procedure, myomectomy is associated with certain risks. These may include excessive blood loss, an infection requiring antibiotic treatment, developing scar tissue, and childbirth complications. In some cases, myomectomy results in injuries to internal organs and structures, such as damaging the ureter, which is the tube that transports urine from the kidney to the bladder. When this happens, additional corrective surgery is required. Choosing a GYN surgical specialist will greatly reduce your risk for such complications.

Recovery times vary from 10 days to 6-8 weeks depending on the type of surgery. This chart details recovery time for a variety of surgical techniques.

The extent of your scarring is determined by the number and size of incisions.  Innovative procedures, such as LAAM, minimize scarring.

Before undergoing surgery, you will likely have many questions for your doctor or OB-GYN. Below are some recommended questions to ask – and background information to help you weigh the answers. You can also download a printable version of these questions.

Women need to be their own best advocate, which is why getting a second opinion is always good practice. Since there are different surgical options for treating fibroids, getting a second opinion is a way you can ask questions about how the surgery will be performed, the recovery time, and possible complications. 

Learn more about the LAAM-BUAO procedure.