Open Myomectomy vs Laparoscopic Myomectomy: A Complete Guide

When fibroids start to interfere with your daily life – through pain, heavy bleeding, or pressure symptoms – it is natural to feel uncertain about the next steps. 

If surgery has been recommended, you may find yourself choosing between two main options: open myomectomy and laparoscopic myomectomy. Both procedures aim to remove fibroids while preserving your uterus but can have many differences in how they are performed, recovery time, and who they are most suitable for.

Understanding how these two approaches compare, and what each one involves, can help you feel more confident as you consider which option best fits your body, your lifestyle, and your future plans.

What is myomectomy and why is it done?

Myomectomy is a surgical procedure that removes uterine fibroids (also called leiomyomas) while preserving your uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy allows you to retain your uterus and the possibility of future pregnancy if that's important to you.

When myomectomy might be recommended

Your doctor may suggest myomectomy if your fibroids are causing symptoms that affect your daily life or reproductive health. 

These can include:

• Prolonged or heavy menstrual bleeding that impacts your quality of life

• Pelvic pain or a feeling of pressure in your lower abdomen

• Difficulty conceiving or recurrent pregnancy loss

• Bladder or bowel symptoms due to fibroid pressure

• Rapidly growing fibroids or fibroids that have reached a significant size

Myomectomy may be particularly suitable if preserving your uterus is important to you – for either personal or medical reasons. Your individual circumstances, symptoms, and reproductive goals will guide whether this procedure is right for you.

There are two main surgical approaches to myomectomy: 

• Laparoscopic myomectomy (minimally invasive)

• Open myomectomy (traditional abdominal surgery)

Knowing the differences between these techniques can help you have more informed conversations with your doctor about which option might work best for your situation.

What is laparoscopic myomectomy?

Laparoscopic myomectomy is a ‘keyhole’ approach to removing fibroids. Instead of one larger cut, your surgeon works through several small openings in your abdomen, using a thin camera (laparoscope) and specialised instruments to find and remove the fibroids.

Here's what laparoscopic myomectomy usually involves:

• This technique needs specialist surgical skills

• Your surgeon makes 3-5 small cuts, each about 0.5-1 cm long

• The fibroids are removed and may be cut into smaller pieces

This approach works best for smaller fibroids that are fewer in number and easier to reach.

What is an open myomectomy?

Open myomectomy, also called abdominal myomectomy, is the traditional approach that uses a larger cut in your abdomen to reach and remove fibroids. This gives your surgeon a clear, direct view of your uterus to work with.

Here’s what open myomectomy usually involves: 

• Your surgeon makes one cut, usually across your bikini line or down your lower abdomen.

• The fibroids can be removed whole without cutting them into smaller pieces.

• The larger opening gives your surgeon better access to work with complex or multiple fibroids.

Your doctor might suggest this approach if you have larger fibroids, several fibroids in different areas of your uterus, or fibroids that sit deep in your uterine wall. It's also the safer choice when keyhole surgery isn't practical for your situation.

If you are unsure whether open myomectomy is right for you, schedule an appointment with Thomson Medical. Our doctors can assess your condition, explain why open surgery may be recommended, and discuss what to expect from the procedure.

Open myomectomy vs. laparoscopic myomectomy: Key differences

Both procedures aim to remove fibroids while keeping your uterus intact, but they differ in approach and what they're best suited for. Understanding these differences can help you and your doctor decide which option fits your needs.

Fertility and pregnancy considerations

Both procedures can help improve your chances of pregnancy when fibroids have been affecting your fertility. 

There are a few things you should keep in mind:

• Open myomectomy may provide stronger uterine wall repair for large or deep fibroids. 

• You may need a caesarean delivery for future pregnancies, depending on where and how deep the cuts were made in your uterus.

• Uterine rupture risk during pregnancy is low but slightly higher after extensive cuts.

Your obstetrician will monitor you closely throughout pregnancy and help you plan the safest delivery approach based on your individual surgery.

If you're concerned about how myomectomy might affect your fertility or future pregnancy, schedule a consultation with Thomson Medical. Our specialists can assess your specific case and create a care plan tailored to your reproductive goals.

Safety and potential complications

Both procedures are generally safe when performed by experienced surgeons, though each comes with its own considerations.

With laparoscopic myomectomy, you can expect lower blood loss and a reduced risk of infection. However, in complex cases where fibroids are harder to reach, there's a chance some fibroid tissue might not be fully removed. This technique also requires a surgeon with specialist keyhole surgery skills.

Open myomectomy often involves more blood loss and carries a higher risk of wound infection because of the larger cut. On the other hand, there's less chance you'll need another surgery for remaining fibroids, and your surgeon has better control when working with challenging anatomy.

Your surgeon will discuss which approach offers you the best balance of safety and effectiveness.

Recovery and getting back to normal

The time it takes to recover differs quite a bit between the two approaches.

After laparoscopic myomectomy, most women can return to light activities within one or two weeks and feel fully recovered by two or four weeks. You'll likely go home the same day or after a short hospital stay.

After an open myomectomy, recovery takes longer – usually around four to six weeks before you're back to your normal routine. You'll also need to stay in hospital for a few days after surgery.

Your individual recovery will depend on factors like the size and number of fibroids removed, your overall health, and how your body heals.

Understanding the costs

The cost of either procedure can vary depending on several factors, and it's worth discussing with your doctor.

Laparoscopic myomectomy may cost more upfront because of the specialised equipment and expertise required. However, open myomectomy can lead to higher indirect costs due to the longer hospital stay and extended recovery time away from work.

Overall costs depend on your healthcare coverage, where you have the procedure done, and your individual medical needs. It's helpful to check with your insurance provider about what's covered.

While understanding these differences is important, it’s worth noting that there's no universally "better" option. The right choice depends on your unique situation, and your gynaecologist will help guide you towards the most suitable approach for you.

Which myomectomy procedure is right for you?

Choosing between laparoscopic and open myomectomy isn't about picking the "best" technique – it's about finding what works best for your body and your goals. 

Several factors will shape this decision, including:

• The size, number, and location of your fibroids

• Whether you're planning to have children in the future

• Your surgeon's experience with each technique

• Your overall health and any previous surgeries you've had

• Access to surgeons with advanced laparoscopic expertise

A consultation with a gynaecologist or fibroid specialist will help clarify which approach suits your needs. They'll assess your specific situation and discuss the option that aligns with your health, your preferences, and your plans for the future. 

The goal is to find a solution that addresses your symptoms while supporting your overall wellbeing and reproductive goals.

FAQ

In which cases is open myomectomy preferred over laparoscopic myomectomy?

Open myomectomy is often preferred when you have very large fibroids (usually over 8-10 cm), multiple fibroids throughout your uterus, or fibroids that are deeply embedded in your uterine wall. It may also be the better choice if you have significant scarring from previous surgeries or if specialist laparoscopic expertise isn't available.

What is an advantage to an open myomectomy?

The main advantage is better access and visibility for your surgeon. This allows for complete fibroid removal, stronger reconstruction of your uterine wall, and safer management when the case is complex.

Which is better: open myomectomy or laparoscopic myomectomy?

Neither approach is universally better – it depends on your individual situation. Laparoscopic surgery offers faster recovery and less discomfort when it's suitable for your case. Open surgery is often the better choice for complex cases with large or multiple fibroids where thorough removal and careful repair are the priorities.

What is the safest procedure for removing fibroids?

Safety depends on your individual circumstances and your surgeon's experience. The procedure that's matched to your specific condition and performed by a skilled surgeon will be the right one for you.

How painful is an open myomectomy?

Open myomectomy often involves more discomfort than laparoscopic surgery because of the larger cut. Pain is managed with medication, and most women find the discomfort improves significantly within 1-2 weeks.

Is an open myomectomy like a caesarean section?

Both procedures involve a cut in your abdomen, entry into your abdominal cavity, and similar recovery timelines. The main difference is that open myomectomy focuses on removing fibroids rather than delivering a baby.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations based on your medical conditions, request an appointment with Thomson Medical.