What is Myomectomy?
A myomectomy is a surgical procedure to remove non-cancerous muscular growths (fibroids/leiomyomas) from the uterine wall. Unlike a hysterectomy, a myomectomy reconstructs the uterine tissue, preserving the womb and maintaining the patient's potential for future pregnancies.
Who Needs a Myomectomy?
Myomectomy is recommended for women who have symptomatic fibroids and wish to keep their uterus for reproductive plans or personal preference.
Key clinical indicators include:
- Heavy, prolonged, or painful menstrual periods leading to anemia.
- Pelvic pressure, abdominal distension, or painful intercourse.
- Fibroids causing bladder or bowel compression (frequent urination or constipation).
- Recurrent miscarriages or unexplained infertility associated with fibroids.
- Rapid growth of fibroids identified during pelvic imaging.
Types of Myomectomy
- Laparoscopic / Robotic Myomectomy: Minimally invasive removal of subserosal or intramural fibroids via small abdominal keyholes.
- Hysteroscopic Myomectomy: Transvaginal, non-incisional removal of submucosal fibroids located inside the uterine cavity.
- Abdominal (Open) Myomectomy: Traditional open procedure used for very large, deep, or numerous fibroids.
Benefits of Myomectomy
- Complete preservation of fertility and uterine function.
- Relief from heavy bleeding, pelvic pressure, and menstrual pain.
- Restoration of normal uterine anatomy and cavity contour.
- Improvement in fertility rates and pregnancy outcomes for fibroid-related subfertility.
What to Expect Before Surgery?
Preparation helps ensure surgical accuracy and minimize intraoperative blood loss:
- Medical Therapy: Medications like GnRH analogs may be prescribed for 1-3 months before surgery to shrink fibroid size and reduce bleeding.
- Diagnostic Imaging: Pelvic ultrasound or MRI to map the exact size, number, and location of fibroids.
- Pre-Op Clearance: Hemoglobin assessment (iron supplementation if anemic) and routine surgical clearance.
- Fasting Instructions: Avoiding food and fluids for 8 hours prior to the procedure.
Complete Procedure
The surgical process involves the following detailed steps:
- Delivery of appropriate anesthesia (general or regional).
- Surgical access through keyhole ports (laparoscopy) or a transverse bikini incision (open).
- Injecting a vasoconstrictive agent into the uterine muscle to minimize blood loss.
- Making an incision directly over the uterine fibroid wall capsule.
- Dissecting and enucleating the fibroid tissue from surrounding healthy muscle.
- Reconstructing and multi-layer suturing of the uterine wall muscle layers to restore structural strength.
- Removing fibroid tissue using a morcellator bag (laparoscopic) or directly (open/hysteroscopic).
- Inspecting for bleeding, rinsing the cavity, and closing incisions.
What to Expect During Surgery?
Surgery lasts between 1 to 3 hours depending on the size, quantity, and position of fibroids. Surgeons focus heavily on meticulous suture closure of the uterine wall to optimize future pregnancy safety.
Laparoscopic vs Open Myomectomy
| Feature | Laparoscopic Myomectomy | Open Abdominal Myomectomy |
|---|---|---|
| Fibroid Suitability | Small to moderate size (usually < 8-10 cm), limited count. | Multiple, very large, or deeply embedded fibroids. |
| Hospital Stay | 1 to 2 Days. | 2 to 4 Days. |
| Recovery | 2 to 3 Weeks. | 4 to 6 Weeks. |
| Blood Loss | Minimal. | Moderate. |
Success Rate and Safety
Myomectomy is highly effective with over 80-90% of women experiencing substantial symptom relief. Pregnancy rates post-myomectomy range between 40-60% depending on age and co-existing fertility factors.
Myomectomy Cost Estimate
| Technique | Estimated Cost Range (INR) |
|---|---|
| Hysteroscopic Myomectomy | ₹80,000 - ₹1,50,000 |
| Laparoscopic / Robotic Myomectomy | ₹1,50,000 - ₹2,80,000 |
| Open Abdominal Myomectomy | ₹1,00,000 - ₹2,00,000 |
Disclaimer: Final cost varies based on number of fibroids removed, operative duration, hospital type, and surgeon expertise.
Recovery Guide & Post-Operative Care
Recovery Timeline
- Day 1-2: Early walking, light diet, management of post-op discomfort.
- Week 1-2: Rest at home; avoid strenuous activities; light walking encouraged.
- Week 3-4: Resume office work for laparoscopic surgery; driving if comfortable.
- Month 3-6: Complete uterine muscle healing; safe to attempt pregnancy after doctor's clearance.
Post-Op Precautions & Care
- Pregnancy Planning: Wait 3 to 6 months before trying to conceive to allow the uterine scar to mature fully.
- Delivery Mode: Future pregnancies may require an elective C-section if deep uterine muscle layers were incised.
- Avoid Heavy Strain: No lifting >5 kg for 4 to 6 weeks.
Frequently Asked Questions
Can fibroids grow back after a myomectomy?⌄
Existing fibroids removed during surgery will not grow back. However, new fibroids can develop from new microscopic cell clusters over time.
Can I deliver naturally (vaginally) after a myomectomy?⌄
If fibroids were deeply embedded in the uterine wall, your obstetrician may recommend a Planned C-section to prevent uterine rupture during labor. Shallow or hysteroscopic removals may allow vaginal delivery.
How long should I wait to get pregnant after myomectomy?⌄
Most doctors advise waiting 3 to 6 months after surgery to allow adequate healing of the uterine tissue before conceiving.
Is a laparoscopic myomectomy painful?⌄
Laparoscopic surgery involves smaller incisions, leading to significantly less post-operative pain compared to open surgery. Pain is managed easily with oral medications.