Laparoscopic Myomectomy

This page is for women who have been told they have fibroids and are weighing whether surgery is truly necessary — particularly those who want to keep their uterus, protect their fertility, or avoid a hysterectomy they are not convinced they need. If your fibroids cause no symptoms, you may need no operation at all; the sections below explain how we tell the difference, and when a myomectomy genuinely helps.

Good fibroid surgery begins with a map, not a scalpel. Before recommending a myomectomy we establish three things with imaging — transvaginal ultrasound, and MRI where the fibroid map is complex: the number, size and exact position of each fibroid; whether any distort the uterine cavity (the submucosal fibroids that most affect bleeding and fertility); and whether your symptoms genuinely correspond to the fibroids rather than to another cause. Heavy menstrual bleeding has its own structured assessment before it is attributed to a fibroid. Only when an identifiable fibroid is plausibly driving a real problem, and conservative options have been weighed, does removal earn its place.

Under general anaesthesia, three to four keyhole incisions (5–10 mm) give access to the pelvis. The uterine wall is opened over the fibroid, the fibroid is enucleated from its capsule, and — the step that matters most for your future — the uterine wall is repaired in layers with careful suturing, because the strength of that scar is what carries a future pregnancy. Energy is used sparingly to protect healthy muscle, and the fibroid is removed through a contained retrieval system. Submucosal fibroids sitting inside the cavity need no abdominal incision at all and are resected hysteroscopically through the cervix. Where a fibroid map is genuinely unsuitable for keyhole surgery, we tell you beforehand and discuss an open approach honestly, rather than converting unexpectedly.

Most women spend one to two nights in hospital and are walking the same evening. Light activity returns within days, and most desk-based work within one to two weeks; heavier work, intense exercise and swimming are best left for four to six weeks while the uterine repair heals internally — feeling well and being fully healed are not the same thing. Because the uterus has been sutured, we give a clear, individualised interval before trying to conceive and explain what it means for delivery planning. Every patient leaves with written recovery guidance and a direct line for questions.

Myomectomy is the uterus-sparing operation, and our default when fertility or uterine preservation matters — but it is not the only path. Asymptomatic fibroids are usually monitored, not operated on. Bleeding can often be controlled medically, including with a hormonal intrauterine system, before surgery is considered. For a woman whose family is complete and whose uterus is extensively involved, a hysterectomy may be the more durable answer, and we will say so plainly; equally, if a hysterectomy has been offered to you as the first option for fibroids, a second opinion is a reasonable thing to seek. The right choice rests on your symptoms, fibroid map, age and plans — never on the size of the fibroid alone.

• AAGL practice guidance on laparoscopic myomectomy and safe tissue extraction
• ESGE consensus on operative laparoscopy
• RCOG and NICE (NG88) guidance on heavy menstrual bleeding and uterine fibroids
• FIGO classification for fibroid mapping, from submucosal to subserosal