Surgical Treatment for Fibroids

Myomectomy is the surgical removal of fibroids. It is used to treat bleeding, infertility, pain, and pressure caused by fibroids. Your gynecologist uses one of four uterine-sparing surgical procedures to remove the fibroids: hysteroscopy, laparoscopy, laparotomy, or robotic-assisted myomectomy. The procedure used depends on the size, number, and location of the fibroids. Because myomectomy preserves the uterus, it may be the preferable option for women who wish to become pregnant. New fibroids may grow after surgery, however, especially if a woman has had multiple fibroids.

Hysteroscopy

During a hysteroscopy the surgeon inserts a thin, lighted scope through the vagina into the uterus. This helps them diagnose and remove fibroids on the inner wall of the uterus. Operative hysteroscopy can be done using local or general anesthesia; you and your surgeon decide which is more appropriate for you. The recovery time takes anywhere from one to three days, depending on the number, size, and location of the fibroids.

Laparoscopy

During a laparoscopy, a lighted scope and highly advanced surgical instruments are placed through small incisions in the abdomen. Your surgeon is able to see and remove fibroids. Laparoscopy is an outpatient procedure that does not require a hospital stay and is performed using general anesthesia. Recovery can last up to two weeks, depending on the number, size, and location of the fibroids removed.

Laparotomy

A laparotomy is performed using general anesthesia. The doctor makes an abdominal incision that is several inches long to remove large fibroids, multiple fibroids, or fibroids that have grown deep into the wall of the uterus. This procedure requires a stay of one to three days in the hospital. A full recovery takes four to six weeks.

Robotic-Assisted Myomectomy

During a robotic myomectomy, your NYU Langone surgeon uses small incisions to place a miniature camera and surgical tools at the surgical site. The tools are controlled using a robotic-assisted surgical device. This device provides a high-resolution, three-dimensional view of fibroids and the surrounding tissue, while also giving your surgeon a greater range of motion than the human hand alone. This allows for less scarring, less postoperative pain, and reduced recovery time. The procedure requires general anesthesia, and you can typically leave the hospital the same day. Full recovery can take up to two weeks.

Hysterectomy, which is the surgical removal of the uterus, is the only treatment guaranteed to prevent fibroids from recurring. NYU Langone doctors consider hysterectomy a definitive treatment best suited to women who do not wish to become pregnant in the future. It is recommended when pain and menstrual bleeding significantly impact quality of life. In rare situations, hysterectomy may be recommended for women with fibroids that grow after menopause.

The decision to pursue a hysterectomy is a valid, reasonable, and acceptable one for those seeking relief from fibroid symptoms. Your doctor can help you decide whether this procedure is appropriate for you.

Hysterectomy can be performed in several ways, depending on the size, number, and location of the fibroid or fibroids. It can be done via open surgery; laparoscopy, in which a lighted scope and other instruments are inserted through small abdominal incisions; robotic-assisted surgery; or vaginal surgery, in which the uterus is removed through the vagina. Virtually all hysterectomies for fibroids can be performed using a minimally invasive approach, which uses smaller incisions and results in quicker recovery time and less post-operative pain.

A hysterectomy may require an overnight hospital stay for less invasive surgeries, or a three-day stay for open surgery. Recovery time is typically up to two weeks for minimally invasive surgery and up to six weeks for open surgery.