Myomectomy Techniques

  • Adam Magos
  • Ioannis Tsibanakos
Part of the Medical Radiology book series (MEDRAD)


Uterine fibroids are common, and if symptomatic and the uterus is to be conserved for child-bearing, myomectomy is the traditional surgical solution. Myomectomy can be done by a variety of techniques, including by laparotomy (open surgery), laparoscopy, hysteroscopy and via the vagina. Each has its indication, and advantages and disadvantages. Open myomectomy is suitable for all cases and remains the only choice when the fibroids are numerous and/or large. Laparoscopic myomectomy is most suited to small to medium sized subserous fibroids but can also be used if the fibroid is intramural. Recently, robotically assisted laparoscopic myomectomy has been introduced into clinical practice, but whether it is cost effective remains to be seen. Hysteroscopic myomectomy is indicated for small intra-cavitary and submucous fibroids. Finally, vaginal myomectomy, widely practised in the nineteenth century, is undergoing a revival as an alternative to laparoscopic and hysteroscopic surgery.


Uterine Artery Embolisation Uterine Cavity Uterine Fibroid GnRH Analogue Laparoscopic Myomectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahmad G, Duffy JMN, Farquhar C, Vail A, Vanderkerchove P, Watson A, Wiseman D (2008) Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000475. doi: 10.1002/14651858.CD000475.pub2
  2. Al-Shabibi N, Chapman L, Madari S, Papadimitriou A, Papalampros P, Magos A (2009) Prospective randomised trial comparing gonadotrophin-releasing hormone analogues with triple tourniquets at open myomectomy. BJOG 116:681–687PubMedCrossRefGoogle Scholar
  3. Al-Shabibi N, Korkontzelos I, Gkioulekas N, Stamatopoulos C, Tsibanakos I, Magos A (2010) Cable ties as tourniquets at open myomectomy. Int J Gynaecol Obstet 110:265–266PubMedCrossRefGoogle Scholar
  4. Aydeniz B, Gruber IV, Schauf B, Kurek R, Meyer A, Wallwiener D (2002) A multicenter survey of complications associated with 21,676 operative hysteroscopies. Eur J Obstet Gynecol Reprod Biol 104:160–164PubMedCrossRefGoogle Scholar
  5. Breech LL, Rock JA (2008) Leiomyomata uteri and myomectomy. In: Rock JA, Jones HW (eds) Te Linde’s operative gynecology, 10th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  6. Casadio P, Youssef AM, Spagnolo E, Rizzo MA, Talamo MR, De Angelis D, Marra E, Ghi T, Savelli L, Farina A, Pelusi G, Mazzon I (2011) Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril 95:1764–1768.e1PubMedCrossRefGoogle Scholar
  7. Chamberlain G (2003) The master of myomectomy. J R Soc Med 96:302–304PubMedCentralPubMedCrossRefGoogle Scholar
  8. Chen CC, Falcone T (2009) Robotic gynecologic surgery: past, present, and future. Clin Obstet Gynecol 52:335–343PubMedCrossRefGoogle Scholar
  9. Davies A, Hart R, Magos AL (1999) The excision of uterine fibroids by vaginal myomectomy: a prospective study. Fertil Steril 71:961–964PubMedCrossRefGoogle Scholar
  10. Di Spiezio Sardo A, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida M, Nappi C (2008) Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Reprod Update 14:101–119PubMedCrossRefGoogle Scholar
  11. Dubuisson J-B (2007) How I perform… the preventive occlusion of the uterine arteries before myomectomy or hysterectomy? Gynecologie Obstetrique Fertilite 35:1264–1267CrossRefGoogle Scholar
  12. Hanstede MM, Emanuel MH, Stewart EA (2008) Outcomes for abdominal myomectomies among high-volume surgeons. J Reprod Med 53:941–946PubMedGoogle Scholar
  13. Hasson HM, Rotman C, Rana N, Sistos F, Dmowski WP (1992) Laparoscopic myomectomy. Obstet Gynecol 80:884–888PubMedGoogle Scholar
  14. Hobo R, Netsu S, Koyasu Y, Tsutsumi O (2009) Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol 113:484–486PubMedCrossRefGoogle Scholar
  15. Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, Chen FD, Gu HZ (2009) Laparoscopic versus open myomectomy–a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 145:14–21PubMedCrossRefGoogle Scholar
  16. Kongnyuy EJ, Wiysonge CS (2011) Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD005355. doi: 10.1002/14651858.CD005355.pub4
  17. Liu H, Lu D, Wang L, Shi G, Song H, Clarke J (2012) Robotic surgery for benign gynaecological disease. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008978. doi: 10.1002/14651858.CD008978.pub2
  18. Magos A (2012) Hysteroscopy and laparoscopy. In: Edmonds DK (ed) Dewhurst’s textbook of obstetrics and gynaecology, 8th edn. Blackwell Publishing, OxfordGoogle Scholar
  19. Magos A, Al-Shabibi N, Korkontzelos I, Gkioulekas N, Tsibanakos I, Gkoutzioulis A, Moustafa M (2011) Ovarian artery clamp: initial experience with a new clamp to reduce bleeding at open myomectomy. J Obstet Gynaecol 31:73–76PubMedCrossRefGoogle Scholar
  20. Makai G, Isaacson K (2009) Complications of gynecologic laparoscopy. Clin Obstet Gynecol 52:401–411PubMedCrossRefGoogle Scholar
  21. Mukhopadhaya N, De Silva C, Mayonda IT (2008) Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 22:677–705CrossRefGoogle Scholar
  22. Neuwirth RS (1978) A new technique for and additional experience with hysteroscopic resection of submucous fibroids. Am J Obstet Gynecol 131:91–94PubMedGoogle Scholar
  23. Neuwirth RS, Amin HK (1976) Excision of submucus fibroids with hysteroscopic control. Am J Obstet Gynecol 126:95–99PubMedGoogle Scholar
  24. Olufowobi O, Sharif K, Papaionnou S, Neelakantan D, Mohammed H, Afnan M (2004) Are the anticipated benefits of myomectomy achieved in women of reproductive age > A 5-year review of the results at a UK tertiary hospital. J Obstet Gynaecol 24:434–440PubMedCrossRefGoogle Scholar
  25. Papalampros P, Gambadauro P, Papadopoulos N, Polyzos D, Chapman L, Magos A (2009) The mini-resectoscope: a new instrument for office hysteroscopic surgery. Acta Obstet Gynecol Scand 88:227–230PubMedCrossRefGoogle Scholar
  26. Ravina JH, Merland JJ, Herbreteau D, Houdart E, Bouret JM, Madelenat P (1994) Preoperative embolization of uterine fibroma. Preliminary results (10 cases). Presse Med 23:1540PubMedGoogle Scholar
  27. Schreuder HW, Verheijen RH (2009) Robotic surgery. BJOG 116:198–213PubMedCrossRefGoogle Scholar
  28. Semm K (1979) New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy and adnectomy. Endoscopy 11:85–93PubMedCrossRefGoogle Scholar
  29. Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M (2008) Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invas Gyn 15:292–300CrossRefGoogle Scholar
  30. Taylor A, Sharma M, Tsirkas P, Arora R, Di Spiezio Sardo A, Mastrogamvrakis G, Buck L, Oak M, Magos A (2005a) Surgical and radiological management of uterine fibroids—a UK survey of current consultant practice. Acta Obstet Gynecol Scand 84:478–482PubMedCrossRefGoogle Scholar
  31. Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A (2005b) Reducing blood loss at open myomectomy using triple tourniquet: a randomised controlled trial. BJOG 112:340–345PubMedCrossRefGoogle Scholar
  32. Taylor A, Sharma M, Buck L, Mastrogamvrakis G, Di Spiezio Sardo A, Magos A (2005c) The use of triple tourniquets at laparoscopic myomectomy. J Gynecol Surg 21:65–72CrossRefGoogle Scholar
  33. Thomas B, Magos A (2011) Subtotal hysterectomy and myomectomy—vaginally. Best Pract Res Clin Obstet Gynaecol 25:133–152PubMedCrossRefGoogle Scholar
  34. Vercellini P, Trespidi L, Zaina B, Vincentini S, Stellato G, Crisgnani PG (2003) Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial. Fertil Steril 79:1390–1395PubMedCrossRefGoogle Scholar
  35. Wen KC, Chen YJ, Sung PL, Wang PH (2010) Comparing uterine fibroids treated by myomectomy through traditional laparotomy and 2 modified approaches: ultraminilaparotomy and laparoscopically assisted ultraminilaparotomy. Am J Obstet Gynecol 202:144.e1-8Google Scholar
  36. Yi YX, Zhang W, Guo WR, Zhou Q, Su Y (2011) Meta-analysis: the comparison of clinical results between vaginal and laparoscopic myomectomy. Arch Gynecol Obstet 283:1275–1289PubMedCrossRefGoogle Scholar
  37. Yu X, Zhu L, Li L, Shi HH, Lang JH (2011) Evaluating the feasibility and safety of vaginal myomectomy in China. Chin Med J Engl 124:3481–3484PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.University Department of Obstetrics and GynaecologyRoyal Free HospitalLondonUK

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