Information about uterine fibroids
Minimally Invasive Therapy Unit & Endoscopy Training Centre
University Department of Obstetrics and Gynaecology
Royal Free Hospital
Pond Street
Hampstead
London NW3 2QG, UK

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A new website for gynaecologists interested in the surgical management of fibroids is now on line. www.fibroidsurgery.org

Different types of myomectomies compared

If you are considering a myomectomy (surgical removal of fibroids) as treatment, the table below will help you understand which type of myomectomy is the most appropriate in your case:

Open (abdominal)
myomectomy
Hysteroscopic
myomectomy
Laparoscopic
myomectomy
Vaginal
myomectomy
What is it?
Fibroids removed via a larger abdominal incision (laparotomy)
Fibroids are removed through the cervix/vagina using a hysteroscope
Fibroids are removed via several small (1/2 - 1 cm) abdominal incisions
Fibroids are removed via the vagina
Which fibroids are suitable?
All fibroids are suitable irrespective of size, site or number - the only option with large, multiple fibroids
Typically a single, small (< 5cm) fibroid which is sited or growing towards the inside of the uterus (uterine cavity)
Maximum of 3 fibroids with a maximum total diameter of 15 cm which are on the outside of the uterus
Fibroids which have prolapsed through the cervix into the vagina. In special cases, vaginal myomectomy can be used with smaller fibroids sited on the outside of the uterus
What are the major advantages of this route?
Greatest chance of all fibroids being removed (if there are multiple fibroids)
No external scars, day-case surgery which can be done under local anaesthesia, quick recovery
Avoids a laparotomy incision with shorter hospitalisation and quicker recovery than open myomectomy
No external scars, shorter hospitalisation, relatively quick recovery
What are the major disadvantages of this route?
Involves laparotomy with inherent risk of wound infection, deep vein thrombosis, pelvic haematoma
Only removes submucous fibroids, so symptoms may recur if there are multiple fibroids present
Long operating (anaesthetic) time, smaller fibroids may be missed so recurrence of symptoms more likely than with open myomectomy
Pelvic haematoma
How long does it take?
1-3 hours
15-60 minutes
2-3 hours
30-60 minutes
How long will I be in hospital?
3-5 days
Usually day case surgery
2-4 days
Day case or up to 2 days
When am I likely to be able to resume normal activities?
4-6 weeks
Few days
2-4 weeks
1-2 weeks
What is the risk of hysterectomy?
Probably < 1%
Virtually zero
Probably < 1%
Probably < 1%
What will happen to my periods?
Periods usually become lighter and less painful
Periods usually become lighter and less painful
Periods usually become lighter and less painful
Periods usually become lighter and less painful
Can I become pregnant afterwards?
Yes
Yes
Yes
Yes

Click here to download a copy of this table (as a pdf file).

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On the subject of surgeons:

Surgeons must be very careful when they take the knife! Underneath their fine incisions, stirs the Culprit -- Life!

Emily Dickinson, American poet (1830-1886)