Myomectomy

Myomectomy is the surgical procedure to remove uterine fibroids.
Unlike a hysterectomy, a myomectomy is designed to remove just the fibroids, while leaving the uterus intact.
Myomectomies are performed in many ways: through an abdominal incision, with a laparoscope, or with a hysteroscope. 

Laparoscopic Myomectomy 

A laparoscopic myomectomy is usually an outpatient surgery, done under general anesthesia. It requires only a short hospital stay and has a relatively quick recovery time.
A laparoscope is a slender telescope that is inserted through the navel to view the abdominal organs.
Two or three small incisions are then made to insert instruments to perform the surgery. Because the incisions are much smaller than with traditional surgery, there is a faster recovery time and smaller scars.
With laparoscopic surgery, the surgeon is not looking into the abdomen directly, but instead he looks at a large video monitor above the patient’s abdomen.
Laparoscopic myomectomies require a very skilled surgeon with a lot of experience to perform. 

Hysteroscopic Myomectomy 

Hysteroscopic myomectomy is a technique that can be performed only if fibroids are within or bulging into the uterine cavity. This procedure is performed as outpatient surgery without any incisions and less post-operative pain. Anesthesia is needed because the surgery may take one to two hours and would otherwise be uncomfortable. A small telescope, the hysteroscope, is passed through the cervix to view the uterine cavity. A small camera is attached to the telescope and the view is projected on a video monitor, which the surgeon uses to perform the surgery.
Electricity passes through the thin wire attachment at the end of the hysteroscope, allowing the instrument to cut through the fibroid. As the fibroid is being cut, the heat from the instrument sears blood vessels creating minimal blood loss. Women are able go home the same day, and recovery is quick, with most patients able to go back to normal activity, work and exercise in one or two days. 

Abdominal Myomectomy 

The most common method of removing fibroids is by making a four- to six-inch incision on the abdomen. The fibroids are then removed through the abdomen. This procedure takes one to two hours, depending on the number and position of the fibroids.
Recovery time is about 2-3 days in the hospital, and six weeks to reach full recovery. Most women will need considerable care at home for several weeks.
One study of women who had myomectomies and women who had hysterectomies for fibroids of the same sizes (about 4 months pregnancy size) found that there was no difference in complications and with an experienced surgeon myomectomy is a safe alternative to hysterectomy. 

Robotic Myomectomy 

Robotic Myomectomy is a minimally invasive procedure that uses laparoscopic myomectomy through small "keywhole" incisions and reduces patient's recovery time. Myomectomy is the only surgical treatment of myomas that preserves fertility. The fibroids are removed surgically from the uterus. This is the best method for women who want to become pregnant, and symptoms such as pressure and heavy bleeding are eliminated or reduced after the fibroids are removed.
The robot-assisted myomectomy combines the thoroughness of the traditional open myomectomy with a minimally invasive procedure, through tiny 1-2 cm incisions in the uterus, and is effective for large tumors. During Robotic myomectomy, the surgeon sits at a special console with hand and foot controls that move the robotic arms during the operation. The robot allows cutting away tissue, cauterizing blood vessels, and suturing, using needles held by pincer like "needle drivers." Robot assisted surgery allows the surgeon greater dexterity than traditional laparoscopy. The surgeon performs the surgery - not the robot.
The robot assisted procedure is performed on an outpatient basis and women can return to work in about a week.

Another, non-invasive option for removing uterine fibroids is through MR-Guided Focused Ultrasound. For more information about this option click here.