The way your surgeon will remove the fibroids depends on how big they are, how many there are and where they are in the uterus.
Abdominal myomectomy
In this type of myomectomy, the surgeon makes a cut in the lower part of your belly to reach the uterus and take out the fibroids. This kind of surgery is sometimes called a laparotomy.
Most of the time, the surgeon will make a low, side-to-side cut near the bikini line. But if the uterus is very big, the surgeon may need to make a straight up-and-down cut instead.
Because this surgery needs a bigger cut than other types of myomectomy, it usually takes longer to heal.
Laparoscopic myomectomy
In this type of myomectomy, the surgeon removes the fibroids through one or more small cuts in your belly using tiny cameras and surgical tools. This is called laparoscopy.
Compared to open surgery, which uses a larger cut, laparoscopy usually causes less bleeding, has fewer complications and leaves less scar tissue. You also are likely to spend less time in the hospital and recover faster.
Sometimes the fibroid is cut into smaller pieces so it can be taken out through one of the small cuts. Other times, the surgeon may need to make a bigger cut to take the fibroid out in one piece. In rare cases, the fibroid is removed through a small cut in the vagina.
Robotic myomectomy
In this type of myomectomy, the surgeon uses a special robot to help with the surgery. Small cuts are made in your belly, and tiny tools are put in through those cuts. The surgeon sits at a nearby console and uses robotic arms to move the tools. There's a surgical team in place at the bedside to help during the surgery.
Robotic myomectomy is a lot like laparoscopic surgery. Both usually cause less bleeding, help you heal faster, and have fewer complications compared to open surgery.
Robotic myomectomy can take more time and cost more than laparoscopic myomectomy, but the results are usually about the same. There haven't been many studies comparing the two types of myomectomy.
Hysteroscopic myomectomy
In a hysteroscopic myomectomy, a surgeon uses a thin, lighted tool and gently puts it through the vagina and cervix to reach the inside of the uterus. A clear liquid is put into the uterus to make it bigger so the surgeon can see better.
The surgeon removes the fibroid by cutting it into smaller pieces. To do this, the surgeon might use a wire loop that uses electricity or a tool with a small blade to shave pieces from the fibroid.
This type of surgery is usually done for smaller fibroids that stick out into the uterus, called submucosal fibroids. If the fibroid is too big, the surgeon might not be able to remove it all at once, and you may need a second surgery.
After the surgery
After the surgery, you'll go to a recovery area where your healthcare team will keep a close watch over you as you wake up.
You can expect some light vaginal bleeding, such as spotting or staining. This can last a few days or up to six weeks, depending on the type of surgery you had.
Most people feel some pain or discomfort after surgery. Your healthcare team may suggest over-the-counter pain medicine, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). Be sure to follow your healthcare team's instructions.
Before you go home, your healthcare team will explain how to take care of yourself. They may talk to both you and the person helping you get home. You'll get information about:
- How to care for the area where you had surgery.
- What pain medicine you can use.
- When to start taking your regular medicines again.
- Limits on activity as you heal, including work, sex and sports.
- Signs to watch for that tell you something's wrong.
- How to get in touch with your healthcare team.
- When your next medical appointments are.