A myomectomy is a surgical procedure designed to remove myomas (also called fibroids) from the uterus, without removing the uterus itself. There are three basic surgical approaches to myomectomy. One approach involves placing a hysteroscope through the cervical canal to remove fibroids from the cavity of the uterus. Another approach utilizes a laparoscope placed through the navel to remove small myomas from the surface of the uterus. Finally, large, multiple or deep myomas are best removed by laparotomy, which is a surgical incision in the lower abdomen made large enough to remove the largest myoma (Abdominal Myomectomy). Other options for treating fibroids include medical therapy to shrink them, an invasive radiology catheterization procedure that blocks the blood supply to the fibroids (Embolization), or high frequency ultrasound ablation under MRI guidance (ExAblate). Embolization and ExAblate therapy are not recommended for patients who wish to become pregnant.

The decision to perform an abdominal myomectomy usually means that the fibroids are large enough and/or of sufficient number to be the likely cause of heavy vaginal bleeding, pelvic pain, infertility or miscarriage problems. An abdominal myomectomy requires general anesthesia (going completely to sleep in the operating room) and a 2-3 day stay in the hospital. Fever, infection, or slow return of bowel function might keep you in the hospital for longer than 3 days. The surgery generally takes between 1 to 3 hours to perform, but the time may vary depending on the number and size of the fibroids, and the need for other procedures. During the surgery, one or several incisions are made in the uterus directly over the fibroids which are then "shelled out" from the uterine wall. The resulting cavity left in the uterine wall is then sewn closed with dissolvable suture. After discharge from the hospital, you will require 3-6 weeks for full recovery, enough to go back to your daily activities and work.

The potential risks of abdominal myomectomy include surgical bleeding that could require a transfusion, infection of the uterus or incision, or injury to internal organs. The risk of surgical bleeding can be reduced with the use of a uterine tourniquet or a medicine injected into the uterus to limit its bleeding. With these measures the risk of transfusion should be less than 5%. Infections and injury to internal organs are very uncommon (<1%). While some patients will have a fever for several days after surgery, prolonged antibiotics are rarely necessary. In very rare cases, the fibroids have destroyed the uterus to such a point that a hysterectomy is necessary. The risk of a hysterectomy is 1/1000. There is a small chance of scar tissue forming between the scar on the uterus and the adjacent fallopian tubes or ovaries. This scarring could potentially limit fertility by kinking the tubes. A dissolvable barrier may be placed over the uterine scar to prevent adhesions from forming. Patients who have had a myomectomy should not get pregnant for at least 2-3 months after surgery to allow the uterus to heal well, and most patients will need to have delivery by Cesarean Section because the uterine scar may not be strong enough to withstand labor contractions. The chance of fibroids recurring is approximately 30%, but only about 10% of patients will require another surgery for their recurrent fibroids. While most patients who have a myomectomy will notice improvements in bleeding, pain and fertility, some will not.