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Treating Fibroids – Which Type of Myomectomy is RIGHT for You?

July 17, 2023

Wondering which type of myomectomy is right for you? Myomectomy is a surgical procedure to remove uterine fibroids while preserving the womb. 

Theatre of surgeons working on myomectomy

For many years, this is the form of treatment women have for fibroids if their medication did not work. This is particularly true if removing the womb entirely is not an option.

Several types of myomectomy are available, each with its benefits and risks. 

In this post, let’s examine the different types of myomectomy available and which type may benefit you.

Treatment choice depends on factors such as the fibroids’ size, number, and location, as well as your reproductive goals and overall health. 

Image of the womb showing different types and locations of fibroids.

Types and Location of Fibroids that Determine Type of Myomectomy

  • Fibroids can be tiny or grow to very large sizes. 
  • A woman may have just a single fibroid in her womb. In contrast, another may have several fibroids within the womb simultaneously.
  • Fibroids’ location is also very important regarding the symptoms they cause and the best treatment options. Mainly there are submucosal, intramural and subserosal, as shown in this image.
    • Submucosal fibroids are located under the inner womb lining. They frequently cause heavy, painful periods as they protrude into the inner womb canal. For women in their reproductive years, submucosal fibroids may cause infertility or miscarriage. Therefore, submucosal fibroids may require treatment regardless of size.
    • The other main types are intramural and subserosal fibroids. You may also find fibroids outside the womb, such as the cervix and broad ligament. Patients with these types usually have bulk symptoms or symptoms of mass effect on adjacent structures such as the bladder and colon. The treatments include UAE, myomectomy, or hysterectomy.
  • Are you having surgery with a view to still bearing children afterwards?
    • Or do you want to manage symptoms but not a hysterectomy? These are examples of reproductive goals.
  • Are you fit for surgery, or do you have other medical problems that could complicate your surgery or recovery?

So now we’ve seen what affects your treatment choice, here are the different types of myomectomy we use commonly:

Abdominal Myomectomy

This is the traditional and oldest method where the doctor makes a cut in the abdomen, similar to a cesarean section. The fibroids are then removed through the cut.

Benefits of abdominal myomectomy include the ability to remove large fibroids and the possibility of repairing the uterus if necessary.

However, it is an invasive procedure with a longer recovery time and a higher risk of complications such as infection and blood loss. This method is still useful for large fibroids.

Laparoscopic Myomectomy

This procedure is performed using a laparoscope. A laparoscope is a thin, lighted instrument inserted through small cuts in the abdomen.

The surgeon observes the fibroids on a screen and removes them with specialized instruments.

Laparoscopic myomectomy offers the advantage of smaller incisions, reduced blood loss, shorter hospital stay, and faster recovery compared to abdominal myomectomy. However, it may not be suitable for removing larger or deeply embedded fibroids.

Robotic Myomectomy

Next is the robotic-assisted myomectomy. And it is a variation of laparoscopic myomectomy where the surgeon controls robotic arms to perform the surgery.

The robotic system provides improved access to remove the fibroids carefully with minimal damage to the womb around them.

This is useful for more complex procedures. The benefits and risks are similar to laparoscopic myomectomy, but robotics can sometimes improve surgical outcomes.

Hysteroscopic Myomectomy

Hysteroscopic Myomectomy removes fibroids within the womb cavity or just under the womb lining, i.e., submucosal fibroids.

A hysteroscope, a thin tube with a camera, is inserted into the womb through the vagina and cervix. The fibroids are visualized and removed using specialized instruments.

Hysteroscopic myomectomy is a minimally invasive procedure with no external incisions, shorter recovery time, and minimal scarring.

However, it is only suitable for certain fibroids and may not be effective for larger or deeply embedded fibroids.

Each method has benefits and risks, and the choice also depends on individual circumstances. 

Factors that may influence the selection of a particular myomectomy method include:

  • Size and location of fibroids: Larger or deeply embedded fibroids may require abdominal or laparoscopic myomectomy, while smaller fibroids located within the uterine cavity may be treated with hysteroscopic myomectomy.
  • The desire for future pregnancy: Myomectomy, in general, preserves fertility. However, hysteroscopic myomectomy may be preferred for women planning to conceive due to its minimal impact on the uterus.
  • Patient’s overall health: The surgeon may consider the patient’s general health, previous surgical history, and individual risk factors when determining the most appropriate myomectomy method.

Risk of Fibroids Returning After Myomectomy

Before we leave, what about the risk of fibroids returning following the myomectomy?

This is a genuine fear, and there is no way to predict whether or not it will happen after any individual surgery.

According to a 2021 study:

Around 15–33% of fibroids recur after myomectomy.

Of these, around 10%-21% of women undergo a hysterectomy within five to ten years.

The rates at which they return and time from surgery vary widely and include the following:

  • 12–15%, at 1 year (Up to 15% will return after 1 year, i.e. in 100 women who have a myomectomy, 15 will have fibroids return after 1 year)
  • 31–43%, at 3 years (By 3 years, over 30% will return)
  • 51–62%, at 5 years (By 5 years after surgery, over 50% will return)
  • And 84% at 8 years, respectively. (By 8 years from surgery, over 80% will have fibroids returning).

It’s essential to consult with a gynaecologist or a specialist to evaluate the circumstances and determine the most suitable myomectomy approach for an individual case.

More Reading

Editing by AskAwayHealth Team


All AskAwayHealth articles are written by practising  Medical Practitioners to help promote quality healthcare. The advice in our material is not meant to replace a qualified healthcare practitioner’s management of your specific condition.
Please get in touch with a health practitioner to discuss your condition, or reach us directly here.

Image Credits: Canva

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