Uterine fibroids are one of the most common health concerns women face, especially between the ages of 30 and 50. For many women, they cause heavy periods, pelvic pain or difficulty getting pregnant. When fibroids need to be removed but you want to keep your uterus, laparoscopic myomectomy is often the preferred choice.
What Is Laparoscopic Myomectomy?
Laparoscopic myomectomy is a minimally invasive “keyhole” surgery used to remove uterine fibroids while keeping the uterus intact. Fibroids, also called leiomyomas or myomas, are non-cancerous growths made of muscle and fibrous tissue. They can be as small as a seed or as large as a melon.
In this procedure, the surgeon makes a few small cuts in the abdomen instead of one large incision. A laparoscope, which is a thin tube with a camera and light, is inserted to show the uterus on a high-definition screen. Using fine instruments, the surgeon removes the fibroids and then stitches the uterine wall back together.
Unlike a hysterectomy, which removes the entire uterus, laparoscopic myomectomy preserves it. This makes it an excellent option for women who want to become pregnant in the future or simply wish to keep their uterus.
Why Is Laparoscopic Myomectomy Done?
Many uterine fibroids remain symptom-free and do not require any treatment. Surgery is usually advised when fibroids start affecting daily life or fertility. Common reasons include:
- Heavy or prolonged periods that may lead to anaemia, weakness and fatigue
- Pain or pressure in the pelvic region, or heaviness in the lower abdomen.
- Urinating more frequently because fibroids press against the bladder.
- Constipation or bowel pressure caused by larger fibroids
- Pain during intercourse
- Infertility or repeated miscarriages linked to fibroids
- Fast-growing fibroids that need timely removal
It may also be an option when medicines or other non-surgical approaches have failed to relieve symptoms adequately.
Who Is a Suitable Candidate?
Keyhole surgery cannot be used to remove all types of fibroids. Your gynaecologist will check your suitability with an ultrasound or MRI. You may be a good candidate if:
- You have a small number of fibroids
- The fibroids are small to moderate in size
- They are located in easy-to-reach areas, such as the outer wall (subserosal) or within the uterine wall (intramural)
- You want to preserve your uterus and fertility
Women who have very large, multiple, or deeply situated fibroids might require another type of surgical procedure.
Types of Laparoscopic Myomectomy
The technique is chosen based on the size, number and location of the fibroids:
| Type | How It Works | Best Suited For |
| Total Laparoscopic Myomectomy | The entire surgery is done through small abdominal cuts | Smaller, accessible fibroids |
| Laparoscopic-Assisted Myomectomy | Laparoscopy guides the surgery; fibroids may be removed through a small vaginal cut | Larger fibroids that are easier to remove this way |
| Robotic-Assisted Myomectomy | A robotic system improves the surgeon’s precision and control | Complex cases or fibroids in difficult positions |
How to Prepare for Laparoscopic Myomectomy
Good preparation helps make the surgery and recovery smoother:
- Tests: Blood tests, pelvic ultrasound or MRI, ECG and sometimes a chest X-ray to check fibroids and overall health
- Medicines: Tell your doctor about all medicines and supplements. Blood thinners may need to be stopped for a few days
- Fasting: Avoid food for about 8 hours before surgery, as advised by your doctor
- Lifestyle: Stopping smoking and controlling diabetes or blood pressure helps healing
- Support: Make arrangements for a family member to accompany you and help with daily activities at home for the first few days.
Step-by-Step Procedure
The surgery is done under general anaesthesia and usually takes 1.5 to 3 hours, depending on the case.
- Anaesthesia: You will remain fully unconscious and pain-free during surgery, while your heart rate, blood pressure, and breathing are closely monitored.
- Small incisions: The surgeon creates 3–4 tiny openings, approximately 0.5–1 cm each, around the navel and lower abdomen.
- Creating space: The abdomen is gently filled with carbon dioxide gas to give a clear view and room to work.
- Camera insertion: The laparoscope is inserted to show the uterus on a screen.
- Fibroid removal: Special instruments carefully separate the fibroids from healthy uterine tissue. Larger fibroids are cut into smaller pieces, often inside a protective bag, and removed through the small cuts.
- Uterine repair: The uterine muscle is stitched in layers with dissolvable sutures to restore its strength.
- Closing: The gas is released, and the small cuts are closed with stitches, surgical glue or adhesive strips.
Recovery After Laparoscopic Myomectomy
Recovery is much quicker and less painful than with traditional open surgery. Most women go home within 24 hours. Here is what a typical recovery looks like:
| Time After Surgery | What to Expect |
| First 24 hours | Monitoring in the recovery room; mild cramping or soreness at the cuts; most patients are discharged |
| Week 1 | Rest at home; light walking to prevent blood clots; basic daily activities resume |
| Weeks 2–4 | Return to desk jobs and light exercise; avoid heavy lifting and high-impact workouts |
| Weeks 4–6 | Full recovery for most women; regular routine and exercise can resume as advised |
| 3–6 months | Usual waiting time before trying to conceive, so the uterus heals completely |
Aftercare Tips
- Take pain medicines exactly as prescribed
- Keep the incision sites clean and dry
- Start with light meals and drink plenty of water
- Walk a little every day, but avoid lifting heavy objects
- Attend all follow-up visits
Contact your doctor if you notice fever, heavy bleeding, increasing pain or redness and discharge from the cuts.
Benefits of Laparoscopic Myomectomy
- Uterus preserved: Keeps the possibility of future pregnancy open
- Small scars: Tiny cuts that fade over time
- Less pain: Smaller wounds mean less discomfort after surgery
- Less blood loss: Lower chance of needing a blood transfusion
- Short hospital stay: Usually 24 to 48 hours
- Faster recovery: Quicker return to work and daily life
- Lower infection risk: Less exposure of internal tissues
- Fewer adhesions: Less internal scar tissue, which is better for fertility
- Symptom relief: Reduced heavy bleeding, pain and pressure
Risks and Limitations
Laparoscopic myomectomy is safe when performed by an experienced surgeon, but like any surgery it has some risks:
- Bleeding during or after surgery
- Infection at the incision sites or inside the pelvis
- Rare injury to nearby organs such as the bladder, bowel or blood vessels
- Formation of adhesions (scar tissue)
- Need to switch to open surgery if fibroids are larger or deeper than expected
- New fibroids may grow over time, so regular check-ups are important
Very rarely, if bleeding cannot be controlled, removal of the uterus may be needed to protect the patient’s life.
Conclusion
Laparoscopic myomectomy is a safe, effective and minimally invasive way to remove uterine fibroids while keeping the uterus intact. With small scars, less pain and a faster recovery, it helps women get relief from heavy bleeding, pelvic pain and fertility problems without major surgery.
However, it is not suitable for every case. Your fibroids’ size, quantity, and location help determine whether you are a suitable candidate for keyhole surgery. If fibroid symptoms are affecting your daily life, consult an experienced gynaecologist for a proper evaluation and a treatment plan that fits your health and future goals.
