Laparoscopic myomectomy in multiple fibroids. Myomectomy is the surgery of choice for women who have symptomatic fibroids and who wish to retain their uterus.

Myomectomy is a uterus-preserving surgical procedure performed to remove uterine fibroids (myomas) while maintaining reproductive potential. It is considered an important treatment option, especially for women with multiple fibroids who wish to preserve fertility or avoid hysterectomy. With advances in minimally invasive surgery, myomectomy has become safer and more effective even in cases involving numerous or large fibroids.

Uterine fibroids are benign smooth muscle tumors of the uterus and are very common in women of reproductive age. They may cause symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms, infertility, or recurrent pregnancy loss. Treatment decisions depend on the size, number, and location of fibroids as well as the patient’s age, symptoms, and fertility wishes. Myomectomy is typically recommended for symptomatic women who want to preserve the uterus or improve pregnancy outcomes.

Myomectomy for multiple fibroids is technically more challenging than removal of a single fibroid. In such cases, careful preoperative planning using ultrasound or MRI is essential to map fibroid number and location. Multiple surgical approaches are available including hysteroscopic, laparoscopic, robotic, and open abdominal myomectomy. Hysteroscopic myomectomy is suitable mainly for small submucosal fibroids, whereas laparoscopic or abdominal approaches are preferred for multiple, large, or deep intramural fibroids.

During surgery, the surgeon identifies and removes each fibroid individually while preserving as much healthy uterine tissue as possible. In cases of multiple fibroids, several incisions may be required on the uterus, followed by meticulous suturing to restore uterine integrity. Advances in laparoscopy and robotic surgery now allow removal of even large or multiple fibroids with reduced blood loss, shorter hospital stay, and faster recovery.

The main advantages of myomectomy include symptom relief and preservation of fertility. Many patients experience improvement in heavy bleeding and pelvic pain after surgery. Additionally, myomectomy can improve the chances of pregnancy in women where fibroids interfere with fertility. Doctors often recommend waiting several months after surgery before attempting conception to allow proper uterine healing.

However, myomectomy also has limitations. Recurrence of fibroids is possible, particularly in women who have multiple fibroids initially. Some fibroids may be missed during surgery, and new fibroids may develop over time. Studies suggest recurrence rates may occur over several years, and some patients may eventually need further treatment or hysterectomy.

Complications associated with myomectomy include bleeding, infection, uterine perforation, adhesion formation, and rarely conversion to hysterectomy. The risk of complications depends on fibroid size, number, and depth. For example, hysteroscopic myomectomy may have complication rates around 13%, particularly in larger or deeply embedded fibroids.

Despite these challenges, myomectomy remains an effective and safe treatment for women with multiple fibroids when performed by experienced surgeons. Modern minimally invasive techniques have expanded its feasibility, allowing removal of even numerous fibroids with good symptom relief and satisfactory fertility outcomes.

In conclusion, myomectomy for multiple fibroids is an important fertility-preserving surgical option. Proper patient selection, surgical expertise, and advanced technology have significantly improved outcomes. While recurrence and complications remain concerns, myomectomy continues to play a vital role in the management of women with symptomatic fibroids who wish to retain their uterus and reproductive potential.