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Magill’s Medical Guide, 9th Edition

Myomectomy

by Anne Lynn S. Chang, , MD

Category: Procedure

Anatomy or system affected: Reproductive system, uterus

Specialties and related fields: Gynecology

Definition: The removal of a uterine myoma, also known as a fibroid or leiomyoma.

INDICATIONS AND PROCEDURES

The most common indication for a myomectomy is the need to remove a symptomatic fibroid. In many cases, these fibroids are large (greater than 8 centimeters). A myomectomy is chosen over a hysterectomy (removal of the uterus) if the patient desires future childbearing and if there is no evidence of malignancy of the uterus. A myomectomy can be performed using abdominal, laparoscopic, vaginal, or hysteroscopic approaches. The choice of approach depends on the location and size of the fibroids, as well as on the experience of the surgeon.

The most common type is abdominal myomectomy. This procedure is performed in the operating room with the patient under general anesthesia. The abdomen is incised and entry into the pelvic cavity is obtained. The uterus is then identified and inspected for fibroids. Some surgeons apply a tourniquet to the uterine arteries for hemostasis. A vasocontrictive agent is injected into the myometrium surrounding the fibroid to minimize blood loss. The myometrium over the fibroid is then incised, and the fibroid is dissected out. Finally, the myometrial defect is closed with a suture to stop blood flow. In patients desiring fertility, care is taken to minimize entry into the endometrial cavity, as the procedure may increase the risk of uterine rupture with pregnancy.

In laparoscopic and vaginal myomectomies, access to the fibroids is obtained using endoscopic instruments and through an incision in the vagina, respectively. In hysteroscopic myomectomies, access to fibroids in the endometrial cavity is obtained using a hysteroscope inserted through the cervical canal. The hysteroscope holds an instrument that shaves away fib-roids in the endometrial cavity.

USES AND COMPLICATIONS

The primary use of myomectomy is the relief of symptoms caused by fibroids. These symptoms can be any of the following: pressure sensation, pelvic pain, dyspareunia (painful intercourse), menorrhagia (excessive menstruation), dysmenorrhea (painful menstruation), urinary urgency or frequency, urinary incontinence, and constipation.

The short-term risks of abdominal myomectomies are the same as those for most pelvic surgeries. These risks are small but include infection, damage to internal organs such as the bowel or bladder, blood loss requiring transfusion, and complications from anesthesia. Long-term consequences include an increased risk of uterine rupture with future pregnancy, the recurrence of fibroid growth, and pelvic adhesion (scar tissue) formation. Laparoscopic myomectomies are less invasive than abdominal myomectomies, but the same short-term and long-term risks are present. Hysteroscopic myomectomies carry less risks than abdominal procedures, since no incision is made on the abdomen and there is no entry into the pelvic cavity, but the risks unique to hysteroscopy exist, such as uterine perforation and fluid overload.

See also Dysmenorrhea; Genital disorders, female; Gynecology; Hysterectomy; Menorrhagia; Menstruation; Muscles; Reproductive system; Tumor removal; Tumors; Uterus; Women’s health.

For Further Information:

1 

Bieber, Eric J., and Victoria M. Maclin, eds. Myomectomy. Malden, Mass.: Blackwell Science, 1998.

2 

DeCherney, Alan H., et al. Current Diagnosis and Treatment: Obstetrics and Gynecology. New York: McGraw-Hill Medical, 2013.

3 

Falcone, T., and M. A. Bedaiwy. “Minimally Invasive Management of Uterine Fibroids.” Current Opinion in Obstetrics and Gynecology 14, no. 4 (August, 2002): 401-07.

4 

Hoffman, Barbara L., et al. Williams Gynecology. New York: McGraw-Hill Medical, 2012.

5 

Rock, John A., and Howard W. Jones III, eds. Te Linde’s Operative Gynecology. 10th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008.

6 

Stenchever, Morton A., et al. Comprehensive Gynecology. 4th ed. St. Louis, Mo.: Mosby/Elsevier, 2006.

7 

Tulandi, Togas, ed. Uterine Fibroids: Embolization and Other Treatments. New York: Cambridge University Press, 2003.

8 

Youngkin, Ellis Quinn, et al. Women’s Health: A Primary Care Clinical Guide. Boston: Pearson, 2013.

Citation Types

Type
Format
MLA 9th
Chang, Anne Lynn S. "Myomectomy." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_0921.
APA 7th
Chang, A. L. (2022). Myomectomy. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Chang, Anne Lynn S. "Myomectomy." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.