Myomectomy is the surgical removal of fibroid from the uterus. It is recommended when the fibroid is causing significant symptoms such as heavy menstrual bleeding, reduced fertility or pressure symptoms such as bladder pressure, urinary frequency, bowel pressure, and bloating.
Myomectomy can be done in different ways depending on the size and location of the fibroid.
Pedunculated fibroids (that grow on stalks), subserosal fibroids (that grow from the outer wall of the uterus) and intramural fibroids (that grow deep within the muscle of the uterus) may be removed laparoscopically (key-hole surgery). Morcellation (cutting the fibroid into smaller pieces in a bag) may then be performed to allow its removal from the key-hole incisions.
Open surgery may be required if the fibroids are large, numerous or deep within the uterus or pelvis.
Submucosal fibroids (that grow from the inside wall of the uterus and protrude into the uterine cavity may be removed hysteroscopically (from the inside of the uterus without any skin incisions).
Morcellation is the process to cutting the large fibroid into smaller pieces within the abdomen to allow its extraction through the small (usually only 1cm) ‘key-hole’ incision. This allows the procedure to be performed in a minimally invasive way by an experienced gynaecologist, reducing the risks of an open surgery.
A potential issue with morcellation is the unexpected finding of malignant cells within the fibroid (the risk of this is between 1 in 600 to 1 in 1000). Morcellating the fibroids into smaller pieces within the abdomen can spread the malignant cells all over the abdomen.
Fibroids are now placed into a special bag (that fits into the ‘key-hole’ incision) within the abdomen, before being morcellated within the contained bag. This will ensure that no abnormal cells spread anywhere outside the bag even if there were unexpected malignant cells within it.
This is the same process of removing a large fibroid uterus in a laparoscopic hysterectomy, when the uterus cannot fit for removal through the vagina (this is the usual way).
There is potential risk of complications with any surgery including myomectomy. This includes: