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Myomectomy is the procedure in which uterine fibroids are surgically removed from the uterus. Myomectomy is considered when fibroids are symptomatic, for example, causing infertility, pain, bleeding, pressure, or other problems. If a patient desires future fertility or does not want her uterus removed, then myomectomy may be a good option. Myomectomies are done in different ways depending on the size, location and number of fibroids.

Abdominal Myomectomy is done by making an abdominal incision, either vertically or horizontally (“bikini cut”), to access the pelvis. The surgeon can then inspect the uterus visually and by touch, for fibroids. An incision is made over the fibroid, down to the level of the fibroid, it is then grasped with an instrument and removed from the normal uterine tissue. The uterus is then sewn back together in several layers.

This approach may be necessary if the fibroids are very large or there are numerous fibroids that need removal, especially if they are in a deeper location making it difficult to visualize the fibroids. The recovery for an abdominal myomectomy usually requires a hospital stay of 2 – 3 days. Total recovery takes 4 – 6 weeks.

Laparoscopic Myomectomy with the assistance of the da Vinci (robotics) is done using small incisions on the abdomen and placing a scope and instruments through these incisions, so that the fibroids can be removed and the uterus repaired. Because the incisions are quite small, the fibroid(s) are morcellated into smaller pieces and removed through the skin incisions or the vagina. The da Vinci facilitates a sound repair of the uterus, reproducing that of an open repair.

This operation is better for removal of fibroids near the surface of the uterus and also for a fewer number of fibroids. Often times when there are numerous fibroids, it is difficult to know the location of all of the fibroids without feeling for them. With laparoscopy, it is difficult to feel fibroids deep in the uterine muscle. The advantage of laparoscopic myomectomy, is faster recovery. It is often possible to go home same day and get back to work two weeks later.

Hysteroscopic Myomectomy is done when the fibroid(s) is in, or bulging into the uterine cavity. This requires general anesthesia, dilation of the cervix, and placement of a hysteroscope to view the uterine cavity and fibroid(s). The fibroid(s) are then ressected using electrocautery and removed in pieces from the cervical opening. Sutures are not necessary with this operation. Patients go home the same day as surgery and generally can return to their regular activities very quickly.

If you are interested in a myomectomy, talk to your doctor to see if you are a candidate.

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