Open myomectomy

Open myomectomy, that is myomectomy through a laparotomy incision, is the traditional technique for removing fibroids. This operation has a long history and remains the only surgical option when the fibroids are numerous and/or large, and there is a wish to preserve the uterus (e.g. for future child bearing).

The incision used for open myomectomy depends on a number of factors, the chief of which is the size of the fibroids. It is often possible to use a horizontal "bikini-line" incision as long as the fibroids do not extend beyond the umbilicus (belly button), but a vertical incision usually has to be used if the womb is larger. If the fibroids are very large or you are anaemic (low in iron), we often use drug treatment for 3 months before surgery to reduce the bulk of the fibroids (to facilitate the procedure) and to correct the anaemia (as these drugs stop your periods).

In addition, we regularly use "triple tourniquets" (vascular ties around the major blood vesels supplying the uterus) to reduce blood loss during surgery, and therefby reduce your chances of having to have a blood transusion. We have developed a special vascular clamp for this procedure, the ovarian artery clamp, which can be used to occlude the ovarian arterial blood supply to the uterus without compromising blood flow to the ovaries or damaging the fallopian tubes. Another innovation is the use of a cable tie applied around the cervix to occlude the uterine arterial blood supply to the uterus. The combination of bilateral ovarian artery clamps and a peri-cervical tourniquet results in minimal blood loss during the myomectomy. You can see a movie of an open myomectomy using the ovarian artery clamps by clicking here.

Open myomectomy is, nonetheless, major surgery and you will probably stay in hospital for 5 days or so. It will then take you a few weeks to get back to your normal activities.