Benign Conditions

Myomectomy

Myomectomy is a surgical procedure to remove uterine fibroids — noncancerous growths that often appear in the uterus during childbearing years. The surgeon’s goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike hysterectomy, which removes the entire uterus, myomectomy surgery removes only the fibroids and leaves the uterus intact, preserving fertility.

Abdominal Myomectomy
In this traditional method, an incision between one to six inches is made. After a two-hour procedure in which the fibroids are removed, a patient can expect to spend two to four days recovering in the hospital. Total recovery can take up to eight weeks.

Laparoscopic Myomectomy
The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. The disadvantage is that only small fibroids can be removed by laparoscopic myomectomy and it is not recommended if there are many fibroids or if the fibroids are deeply embedded in the uterine wall. Laparoscopic surgery is usually performed as out-patient surgery under general anesthesia.

The procedure can take one to three hours, depending on the number, size, and depth of the fibroids within the muscle wall. Following laparoscopic myomectomy many women are able to leave the hospital the same day, although a one-night stay may be necessary. Because the incisions are small, recuperation is usually associated with minimal discomfort. After laparoscopic myomectomy, women usually return to normal activity within 10 to 14 days.

During this procedure a laparoscope (a thin fiber-optic device that transmits light and a video image) is inserted through a small incision, usually in the navel, to view the uterus. The image from the camera attached to the end of the laparoscope is seen on a video monitor. Two or three small (half-inch) incisions are made below the pubic hairline and instruments are inserted through these incisions to perform the surgery. The fibroids are detached from the uterus and removed. Following removal of the uterine fibroids, the openings in the uterus are stitched closed with the use of specially designed instruments.

Robotic Myomectomy
A robotic myomectomy is minimally invasive, using tiny 1-2 cm incisions to remove large tumors. The surgeon sits at a special console with hand and foot controls that move the robotic arms during the operation. The arms of the robot are extremely nimble and are manipulated by the surgeon using joystick-like controls. The robot also has a camera that gives the surgeon a magnified 3-D view. Very small blood vessels and nerves can be seen clearly and can be spared.

The hand movements of the surgeon are duplicated in the patient by the robot, but on a much smaller scale. The robot’s wrist can turn nearly 360 degrees; it eliminates any tremor in a surgeon’s hands, and for delicate work, “motion scaling” software reduces a surgeon’s actual hand movements to much smaller, finer instrument movements.

The robot assisted procedure is performed on an outpatient basis and women can return to work in about a week.

For information on other treatment options for fibroids, visit our Fibroid Clinic page.