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Laparoscopic myomectomy in Goa: keeping the womb
Laparoscopic myomectomy is keyhole surgery that removes fibroids while the womb is kept. Through a few small cuts in the abdomen, each fibroid is shelled out of the womb wall and the wall is stitched closed in layers. In Goa, Heartbeats IVF plans it around your symptoms and, where it matters, a later pregnancy.
What is a laparoscopic myomectomy?
A myomectomy takes out the fibroids and leaves the womb in place. "Laparoscopic" means it is done by keyhole: a thin camera and fine instruments go in through three or four small cuts, each roughly the width of a fingertip, while you are under general anaesthesia. The womb, tubes and ovaries stay where they are, so periods carry on and a pregnancy remains possible afterwards.
This is different from a hysterectomy, where the whole womb is removed. For a woman who still hopes to have a child, or who simply wants to keep her womb, a myomectomy is the operation that is discussed.
Who is a laparoscopic myomectomy suited to?
It is usually considered when fibroids are causing a problem and the womb is to be kept. For example:
- Heavy or long periods linked to fibroids, often with low haemoglobin.
- Pressure on the bladder or bowel, a feeling of heaviness, or pain.
- A fibroid on a stalk (pedunculated) that can twist and cause sudden, severe pain, or a fibroid that has caused repeated bouts of pain as it outgrows its blood supply (degeneration).
- A fibroid in the wall of the womb that pushes on the cavity, found during fertility tests or before IVF.
- A fibroid that is growing between scans and may cause trouble in a future pregnancy.
Keyhole removal suits fibroids that sit on the outer surface of the womb or within its wall, where they can be reached from the outside. Whether it suits you depends on how many fibroids there are, how big they are and exactly where they lie. A small fibroid that is causing no symptoms often needs no operation at all; our page on fibroids and fertility explains which ones usually matter.
When is a different route chosen?
- A fibroid inside the womb cavity is usually removed from below with a hysteroscope, with no cut on the abdomen. See laparoscopy and hysteroscopy.
- Very large fibroids, or a great many of them, may be better removed through a single larger cut (an open myomectomy). The choice is made on your scans, not on a fixed size limit.
- Small fibroids away from the cavity are often watched, especially when time and egg reserve matter more than the fibroid does.
Getting ready for the operation
An ultrasound maps each fibroid, and an MRI is sometimes added when there are several or the picture is unclear. Blood tests check your haemoglobin. If heavy periods have left you anaemic, iron or other treatment is given first, so that you come to surgery stronger. Some women are given a medicine for a few months to shrink the fibroids and stop the bleeding before the operation; our doctors explain whether this helps in your case and what its side effects are.
You will be told about the fasting time, which of your usual medicines to pause, and what will happen on the day. It is a good moment to ask every question you have, including what will be done if something unexpected is found.
How the fibroid is removed and the womb wall is stitched
The surgeon makes a cut in the muscle of the womb over the fibroid and gently separates the fibroid from the healthy muscle around it. Once it is out, the gap left behind is closed with stitches in one or more layers. This stitching is the most important part of the operation for a woman who wants a pregnancy later, because careful closure helps the wall heal well.
The fibroid is then cut into smaller pieces so that it can come out through one of the small cuts, often inside a closed bag. The tissue is always sent to the laboratory to be examined. Very rarely, a growth that looked like an ordinary fibroid turns out to be a cancer called a sarcoma; this is one reason the scans are reviewed carefully before keyhole removal is advised.
Risks to know before you agree
Every operation carries some risk, and you should hear about them plainly before you sign the consent form:
- Bleeding, which sometimes needs a blood transfusion.
- Infection of a wound, the urine or the pelvis.
- Rarely, injury to the bladder, bowel or a blood vessel.
- Changing to an open operation during surgery, if keyhole removal is not safe on the day.
- Scar tissue (adhesions) forming inside the pelvis, which can affect the tubes.
- Very rarely, removing the womb to control bleeding that cannot be stopped any other way. This is discussed with you beforehand.
New fibroids can grow in the years after a myomectomy, because the tendency to form them remains. The operation aims to relieve the trouble the present fibroids are causing; our doctors will tell you honestly what can and cannot be expected for you.
Recovery after laparoscopic myomectomy
Most women stay in hospital for a day or two. You are encouraged to get up and walk early, which helps the bowel and lowers the risk of clots. Shoulder-tip ache from the gas used during keyhole surgery is common for a day or two and passes on its own.
- Light work at home and desk work are often possible after about two weeks.
- Lifting, heavy housework and exercise usually wait about four to six weeks.
- Intercourse waits until your doctor says the wounds and the womb have healed, usually a few weeks.
- A follow-up visit checks the wounds and goes through the laboratory report.
Contact us straight away if you have a fever, pain that is getting worse rather than better, heavy bleeding, repeated vomiting, or redness and discharge from a wound.
Planning a pregnancy after a myomectomy
The stitched womb wall needs time to heal before it carries a pregnancy. The wait is usually about three to six months, depending on how many fibroids were removed and how deep the cuts went. Our doctors set the exact time for you after the follow-up scan.
If the cavity was opened or the cut went deep into the wall, a planned caesarean is often advised for the birth, because labour puts strain on the healing scar. When the cuts were shallow, a normal delivery may still be possible; this is decided for each woman. Whatever the plan, tell every doctor who looks after you in pregnancy that you have had a myomectomy. If a fibroid is first found during pregnancy, it is usually left alone until after the birth; pain from a fibroid outgrowing its blood supply usually settles with rest and pain relief. Sudden, severe pain in the abdomen during pregnancy needs urgent care, because very rarely the scar can give way. Pregnancies after a myomectomy are watched more closely; see our page on high-risk pregnancy care.
If you are also planning IVF
When egg reserve is low, or age means time matters, waiting several months after surgery before starting treatment uses up precious time. Some couples therefore have eggs collected and embryos frozen first, then the myomectomy, and the embryo is transferred once the womb has healed in a frozen embryo transfer cycle. Whether this order suits you depends on your egg reserve, your age and the fibroids themselves.
Where is the surgery done, and where can I consult?
The operation is done here in Goa, where the practice has its own operating theatre and wards. Your first consultation can be at whichever of our clinics suits you; the contact page lists them with their hours. Bring every scan report and earlier operation note you have, and the scan pictures if you have them. APPOINTMENTS ARE COMPULSORY FOR DOCTOR CONSULTATION.
Questions about laparoscopic myomectomy
Is a laparoscopic myomectomy a major operation?
It is a planned operation under general anaesthesia, but it is done through small cuts rather than one large one. Most women go home within a day or two and are back to light activity in about two weeks.
Will my womb be taken out during a myomectomy?
No, the purpose of a myomectomy is to keep the womb. Only the fibroids are removed. Removing the womb is a different operation, and it is considered during a myomectomy only in the very rare event of bleeding that cannot be controlled otherwise.
How large a fibroid can be removed by keyhole surgery?
There is no single cut-off size. The number of fibroids, their size and their position are looked at together on your scans. Some large fibroids can still be removed by keyhole, while some women with many fibroids are better served by an open operation.
How soon can we try for a baby after a laparoscopic myomectomy?
Usually after about three to six months, once the stitched womb wall has healed. The exact time depends on how deep the cuts were, and our doctors confirm it after your follow-up scan.
Can I have a normal delivery after a myomectomy?
Sometimes. If the cuts were shallow, a normal delivery may be possible; if the cavity was opened or the cut went deep, a planned caesarean is often advised. Your operation note guides this decision.
Will the scars show after keyhole fibroid removal?
There are usually three or four small cuts, one of them often hidden in the navel. They usually fade and become less noticeable over the following months.
Where is laparoscopic myomectomy done, and where can I consult?
The surgery is done in Goa. You can consult at whichever of our clinics suits you, and the team will explain the dates and the plan.
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What you read here explains fertility care in general terms and cannot replace a consultation. Decisions about your own care should be made with a doctor who knows your history and has seen you. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.