Myomectomy is the surgical removal of fibroids, leaving the uterus in place. In 33% of all hysterectomies, the reason for surgery is problems related to fibroids. Therefore, Myomectomy is an alternative to hysterectomy. Myomectomy is most often performed when the woman desires a future pregnancy or when she wishes to retain her uterus. Today, there are several options available for this surgery. In most caes, the size and location of the fibroids will determine the appropriate surgical technique. Small fibroids may be removed through less invasive hysteroscopy or laparoscopy procedures, but large, multiple, or inaccessible fibroids usually require laparotomy for removal. 

Myomectomy, when performed by an expert, can usually be accomplished with minimal blood loss. It is rare that a myomectomy is converted during surgery to an unplanned hysterectomy because of uncontrollable bleeding. The two major concerns with performing a myomectomy are minimizing blood loss and preventing surgically induced adhesions (scar tissue) that may impair fertility. Depending upon the location of the fibroids, myomectomy can be performed by either an abdominal or vaginal approach.

• Operative Hysteroscopy: When the fibroid is bulging into the uterine cavity (submucous), it is usually possible to remove it by operative hysteroscopy. During this procedure, the physician inserts a hysteroscope through the cervix into the uterus.
• Operative Laparoscopy: If the fibroids are located on the outside wall of the uterus, then operative laparoscopy can be used. The physician places a laparoscope into the abdomen through a small incision near the naval and then uses surgical instruments.

Laparotomy: Laparotomy is often performed to remove large, multiple, or inaccessible fibroids. The physician makes an incision in the abdominal wall. After a patient has undergone this surgery, a cesarean section may be needed for delivery because the muscular wall of the uterus may be weakened by the removal of many or large fibroids.

SIDE EFFECTS

There can be post-operative bleeding after a Myomectomy.
Patients may have some nausea and incisonal dyscomfort. The patients are likely to have 2- 3 days of abdominal cramping due to uterine suture placement.

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