Introduction
A myomectomy is a surgical procedure to remove uterine fibroids (leiomyomas), which are noncancerous growths that appear in the uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy only removes the fibroids and leaves the uterus intact. This makes it the preferred treatment for women who want to become pregnant in the future or who simply want to keep their uterus. Fibroids can cause significant symptoms, including heavy menstrual bleeding, pelvic pain, frequent urination, and difficulty getting pregnant. Removing them can greatly improve these symptoms and enhance a woman’s quality of life.

Surgical Procedure
There are three main ways to perform a myomectomy, depending on the size, number, and location of the fibroids:
1. Abdominal Myomectomy (Open Surgery): The surgeon makes an incision in the lower abdomen (usually a horizontal “bikini line” cut) to access the uterus and remove the fibroids. This approach is typically used for very large or numerous fibroids.
2. Laparoscopic or Robotic Myomectomy: This is a minimally invasive approach. The surgeon makes several small incisions in the abdomen and inserts a laparoscope (a thin tube with a camera) and specialized surgical instruments. The fibroids are cut into smaller pieces and removed through the small incisions. Robotic assistance provides the surgeon with a 3D view and greater precision.
3. Hysteroscopic Myomectomy: This method is used for fibroids that bulge into the uterine cavity (submucosal fibroids). No abdominal incisions are made. The surgeon inserts a resectoscope through the vagina and cervix into the uterus to shave off and remove the fibroids.

Surgical Risks
While myomectomy is generally safe, it carries standard surgical risks, including adverse reactions to anesthesia, bleeding, and the potential for blood clots in the legs or lungs.

General Complications
Common complications after a myomectomy include:
– Pain and cramping in the abdomen or pelvis.
– Vaginal bleeding or spotting for a few days to weeks.
– Infection at the incision site or inside the uterus.
– Adhesions: Scar tissue can form inside the abdomen or uterus after surgery, which could potentially cause pain or affect fertility.

Rare but Serious Complications
Severe complications are rare but can include:
– Excessive bleeding: In rare cases, severe bleeding during surgery may necessitate a blood transfusion or, in extreme life-threatening situations, an emergency hysterectomy.
– Damage to surrounding organs: The bladder, bowels, or ureters could be injured during the procedure.
– Pregnancy complications: A myomectomy can weaken the uterine wall. If you become pregnant later, there is a small risk of uterine rupture during labor, so a Cesarean section (C-section) is often recommended.

Pre-operative Preparation
Preparation typically involves:
– Medical Evaluation: Blood tests, pelvic exams, and imaging (like ultrasound or MRI) to map the fibroids.
– Fasting: Do not eat or drink for 8 to 12 hours before the surgery.
– Medication adjustments: You may need to stop taking certain medications, especially blood thinners, before surgery. Sometimes, hormonal medications are prescribed months before surgery to shrink the fibroids and reduce bleeding.

Post-operative Care
After surgery, you will be monitored in the recovery room. Hysteroscopic and laparoscopic myomectomies are often outpatient procedures, meaning you can go home the same day. An abdominal myomectomy usually requires a hospital stay of 1 to 3 days. Pain medication will be provided.

Wound Care
– Keep incisions clean and dry. Follow your surgeon’s instructions for showering.
– Do not soak in a bath or swim until cleared by your doctor.
– Watch for signs of infection, such as redness, swelling, or drainage from the incisions.

Diet
Start with clear liquids and gradually advance to a normal diet as tolerated. A high-fiber diet and plenty of fluids are recommended to prevent constipation, as straining can cause pain and put pressure on the healing incisions.

Post-discharge Notes
Recovery time varies by procedure:
– Hysteroscopic: 1 to 2 days.
– Laparoscopic/Robotic: 2 to 4 weeks.
– Abdominal: 4 to 6 weeks.
Avoid heavy lifting, strenuous exercise, and sexual intercourse until your doctor says it is safe. Contact your healthcare provider if you experience heavy vaginal bleeding, severe abdominal pain, fever, or difficulty urinating.