Uterine fibroids are extraordinarily common — they affect up to 70% of women by age 50, though not all cause symptoms. For women who have problematic fibroids but wish to preserve their uterus — whether for future pregnancy, personal preference, or cultural reasons — myomectomy (surgical removal of fibroids while keeping the uterus intact) is the answer. And today, thanks to robotic and laparoscopic technology, myomectomy can be performed with minimal incisions, minimal blood loss, and a rapid return to normal life. Dr. Shweta Mendiratta, robotic surgeon in Faridabad, explains everything you need to know.
What Are Uterine Fibroids?
Fibroids (leiomyomas or myomas) are non-cancerous growths arising from the muscle tissue of the uterus. They vary enormously in size — from a few millimetres to several centimetres — and in location:
- Intramural: Within the uterine muscle wall (most common)
- Submucosal: Projecting into the uterine cavity (most likely to cause heavy bleeding and fertility problems)
- Subserosal: Projecting outward from the uterine surface
- Pedunculated: Attached to the uterus by a stalk
A woman may have a single fibroid or many (multiple fibroids), and the distribution matters for surgical planning.
When Do Fibroids Need Treatment?
Many fibroids are asymptomatic and require no treatment beyond monitoring. Treatment is recommended when fibroids cause:
- Heavy or prolonged menstrual bleeding (leading to anaemia)
- Pelvic pain or pressure
- Urinary frequency or difficulty emptying the bladder
- Constipation or rectal pressure
- Difficulty conceiving or recurrent miscarriage
- Significant uterine enlargement
Why Choose Myomectomy Over Hysterectomy?
Hysterectomy — uterine removal — is the definitive cure for fibroids, but it ends a woman’s ability to conceive and many women prefer to preserve their uterus. Myomectomy removes the fibroids while leaving the uterus intact, allowing future pregnancy and preserving the uterus for women who are not yet ready for hysterectomy.
The trade-off is that fibroids can recur after myomectomy — approximately 20–30% of women require further treatment within 5–10 years. However, for women who want to conceive or who are years away from menopause, myomectomy is often the right choice.
Types of Myomectomy
Hysteroscopic Myomectomy
For submucosal fibroids (those inside the cavity), the fibroid can often be removed entirely through the cervix using a hysteroscope — no incisions at all. This is an outpatient procedure with very rapid recovery. It is the preferred approach for submucosal fibroids causing heavy bleeding or fertility problems.
Laparoscopic Myomectomy
For intramural or subserosal fibroids, laparoscopic myomectomy uses 3–4 small port incisions to access and remove the fibroid. The fibroid is then morcellated (divided into smaller pieces) for removal through the ports, or removed through a small incision using a containment bag.
Robotic Myomectomy
Robotic myomectomy offers particular advantages for large fibroids, multiple fibroids, or fibroids in difficult locations. The robotic system allows:
- Precise dissection with 3D visualisation
- Multi-directional instrument movement (wristed instruments) that exceeds the range of human wrists
- Superior suturing ability — critical for closing the uterine defect securely after fibroid removal
- Reduced blood loss through more precise haemostasis
Secure uterine closure after myomectomy is critical for subsequent pregnancy safety. The robotic platform enables suturing that is as precise — or more precise — than open surgery, which is why robotic myomectomy is increasingly preferred for women planning future pregnancies.
Open (Abdominal) Myomectomy
Reserved for very large uteri, very numerous fibroids, or cases where minimal-access surgery is not feasible. Recovery is 6–8 weeks.
Myomectomy and Fertility
Removing fibroids that distort the uterine cavity or impair blood supply to the lining can significantly improve fertility. Studies show that myomectomy for submucosal fibroids improves IVF pregnancy rates substantially. Dr. Mendiratta carefully plans the procedure to maximise fertility outcomes — avoiding unnecessary myometrial trauma and ensuring meticulous repair.
Recovery After Robotic Myomectomy
- 1–2 nights in hospital
- 2–3 weeks to return to light activity
- 4–6 weeks to full recovery
- Pregnancy is typically recommended no sooner than 3–6 months after myomectomy, to allow adequate uterine healing
Frequently Asked Questions (FAQs)
Q1. Can fibroids become cancerous?
The risk of a uterine fibroid being or becoming malignant (leiomyosarcoma) is very small — approximately 1 in 1000. However, if a fibroid grows rapidly (especially after menopause), further investigation is warranted.
Q2. Will fibroids grow back after myomectomy?
Existing fibroids are permanently removed, but new ones can develop. The recurrence rate is approximately 20–30% over 5–10 years. After menopause, regrowth is very unlikely as fibroids depend on oestrogen.
Q3. Can I deliver vaginally after myomectomy?
This depends on the size, depth, and location of the fibroid removed and the extent of the uterine incision. Dr. Mendiratta will advise you on the safest mode of delivery after reviewing your surgical notes.
Q4. Does fibroid size matter for surgery?
Yes and no. Even very large fibroids can be removed laparoscopically or robotically by experienced surgeons. However, a very enlarged uterus (larger than a 16-week pregnancy) may sometimes require an open approach.
Q5. How long after myomectomy can I try to conceive?
Dr. Mendiratta typically recommends waiting 3–6 months after myomectomy before attempting pregnancy, to allow adequate uterine healing and reduce the risk of uterine rupture during labour.
Get In Touch With Dr. Shweta Mendiratta
Phone: +91-8130048652 | +91-9999093503
Email: shwetasmendiratta@gmail.com
Yatharth Super Speciality Hospital
Plot No 9, Sector-20, Krishna Nagar, New Industrial Township, Faridabad, Haryana 121007
Phone: +91 8178-939442
Mediclub Gynae ‘N’ Neuro Clinic
Pilot No. 857 Sector 21 C, Faridabad Delhi, Haryana 121001
