Laparoscopic Myomectomy (Fibroid Removal)

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Uterine fibroids are one of the most common benign growths affecting women of reproductive age. For some women, fibroids can cause heavy bleeding, pelvic pain, bloating, or difficulty conceiving.

Laparoscopic myomectomy is a minimally invasive procedure designed to remove fibroids through small incisions while keeping the uterus intact. It offers the benefits of quicker recovery, less pain, and minimal scarring compared to traditional open surgery. For many women, it is an effective and uterus-sparing option that supports both symptom relief and future fertility.

What Is a Laparoscopic Myomectomy?

A laparoscopic myomectomy is a type of keyhole surgery used to remove fibroids from the uterus. The surgeon makes three to four small incisions in the abdomen and uses a laparoscope — a thin instrument with a camera — to visualise the pelvic organs. Specialised tools are used to carefully remove the fibroids while preserving the healthy uterine tissue.

Once the fibroids are removed, the uterine wall is reconstructed. In some cases, the fibroid tissue is broken into smaller pieces (a process called morcellation) to allow it to be removed through the small incisions.

Unlike a hysterectomy, a myomectomy does not remove the uterus. This is particularly important for women who wish to conceive in the future or retain their uterus for personal or medical reasons.

What Symptoms Can It Treat?

Laparoscopic myomectomy is used to treat fibroids that cause:

• Heavy or prolonged menstrual bleeding
• Pelvic pain or cramping
• Pressure or bloating in the lower abdomen
• Pain during intercourse
• Frequent urination or difficulty emptying the bladder
• Constipation or bowel discomfort
• Infertility or repeated miscarriage related to fibroid location

Even when fertility is not a concern, the procedure can provide meaningful relief from symptoms that interfere with everyday life and well-being.

Who Is a Good Candidate for Laparoscopic Myomectomy?

Laparoscopic myomectomy is best suited for women who:

• Have a moderate number of fibroids
• Have fibroids that are not excessively large
• Have fibroids that are accessible through a minimally invasive approach
• Want to preserve their uterus
• Are looking for a shorter recovery period than open surgery
• Are in generally good health for anaesthesia and surgery

This procedure may not be ideal for women with very large fibroids, numerous fibroids in different locations, or those with complex surgical histories. In such cases, abdominal myomectomy (open surgery) may be considered. Your doctor will assess your condition using ultrasound or MRI to determine the most appropriate surgical plan.

What Happens Before Laparoscopic Myomectomy?

Before the procedure, a full preoperative assessment is conducted, including:

• Pelvic ultrasound or MRI to evaluate the number, size, and location of fibroids
• Blood tests to assess haemoglobin levels and rule out anaemia
• Medical history review and anaesthetic assessment
• Discussion of fertility goals and treatment expectations

In some cases, medications such as GnRH agonists may be prescribed to shrink the fibroids and reduce blood loss during surgery. Your doctor will also provide instructions on fasting, medications, and what to bring on the day of the procedure.

What Happens During a Laparoscopic Myomectomy?

Laparoscopic myomectomy is performed under general anaesthesia and typically takes between one and three hours, depending on complexity.

• Small incisions (usually 0.5–1 cm) are made in the lower abdomen
• A laparoscope and surgical instruments are inserted
• The fibroids are carefully dissected and removed
• The uterine muscle is reconstructed and the incisions are closed
• Most patients go home the same day or after an overnight stay

Advanced laparoscopic techniques help minimise trauma to the uterus and surrounding organs, which is especially important for women planning future pregnancies.

What Is Recovery Like?

Recovery from laparoscopic myomectomy is generally much faster than open surgery. Most women experience:

• Mild to moderate abdominal discomfort or bloating for a few days
• Vaginal spotting for up to a week
• Fatigue as the body heals

Most patients can:

• Resume light activities in 3–5 days
• Return to work within 1–2 weeks
• Avoid heavy lifting and strenuous exercise for 4–6 weeks
• Resume sexual activity after 4–6 weeks or as advised by your doctor

Your doctor will schedule follow-up appointments to check on healing and discuss long-term plans, including family planning if relevant.

How Does It Compare to Open Myomectomy?

Laparoscopic myomectomy offers several advantages over traditional open surgery:

Laparoscopic Myomectomy

• Minimally invasive
• Smaller incisions, less scarring
• Shorter hospital stay (often same-day discharge)
• Faster recovery (2–3 weeks)
• Less postoperative pain
• Lower risk of infection and blood loss

Open (Abdominal) Myomectomy

• Requires a larger incision
• More suited for very large or numerous fibroids
• Longer hospital stay (2–3 days)
• Recovery period of 4–6 weeks
• More postoperative discomfort

However, there are cases where open myomectomy is necessary or preferred. Your gynaecologist will recommend the approach that offers the safest and most effective outcome based on your individual needs.

Can You Get Pregnant After Laparoscopic Myomectomy?

Yes. One of the key benefits of myomectomy is that it preserves the uterus, making future pregnancy possible. For many women, removing fibroids improves the likelihood of conception, especially when fibroids distort the uterine cavity or interfere with implantation.

Depending on the extent of surgery and the uterine repair required, your doctor may advise waiting three to six months before trying to conceive. In some cases, a caesarean section may be recommended in future pregnancies to prevent the risk of uterine rupture.

Are There Any Risks?

Laparoscopic myomectomy is generally safe, especially when performed by an experienced gynaecological surgeon. However, as with all surgical procedures, there are potential risks, including:

• Bleeding (rarely requiring transfusion)
• Infection
• Injury to nearby organs (e.g., bladder, bowel)
• Scar tissue (adhesions)
• Fibroid recurrence
• Conversion to open surgery if needed for safety reasons

Your doctor will discuss these risks in detail and explain how they are minimised through careful planning and technique.

When Should You Consider Laparoscopic Myomectomy?

You may benefit from this procedure if you:

• Have fibroids causing heavy bleeding, pain, or pressure
• Are planning to conceive in the future
• Want to avoid hysterectomy
• Prefer a minimally invasive option with faster recovery
• Have not responded to medications or non-surgical treatments

An early consultation and proper imaging can help determine whether laparoscopic myomectomy is right for you.