Conservative myomectomy

Conservative myomectomy is a surgical procedure aimed at removing uterine fibroids (benign tumors) while preserving the uterus. Unlike hysterectomy, which involves complete removal of the uterus, conservative myomectomy maintains a woman’s reproductive potential and is therefore the preferred treatment option for patients who plan future pregnancies.

Uterine fibroids (also referred to as fibromyomas or leiomyomas) are benign neoplasms arising from the smooth muscle tissue of the uterus. They may cause symptoms such as pelvic pain, heavy or prolonged menstrual bleeding, pressure on adjacent organs, and in some cases infertility or difficulty with conceiving.

Indications for conservative myomectomy

• Recurrent pregnancy loss (habitual miscarriage).
• Large intramural fibroids with pronounced centripetal growth.
• Presence of fibroids considered a likely cause of infertility.
• Late reproductive age with limited time for realization of pregnancy plans.

Types of conservative myomectomy

1. Laparoscopic myomectomy. The procedure is performed through small abdominal incisions using a laparoscope — a thin tube equipped with a camera and surgical instruments. Advantages include minimal invasiveness, shorter recovery time, lower risk of complications, and reduced scarring. Limitations: suitable mainly for small to medium-sized fibroids.
2. Hysteroscopic myomectomy. Submucosal fibroids located within the uterine cavity are removed transvaginally through the cervical canal using a hysteroscope. Advantages include absence of abdominal incisions and rapid recovery. Limitations: applicable only for submucosal fibroids; not suitable for intramural or subserosal lesions.
3. Abdominal (open) myomectomy. Performed through a laparotomy incision, providing full access to the uterus. This approach is used for large or multiple fibroids. Advantages include the ability to remove extensive or numerous tumors. Disadvantages include longer recovery time, presence of an abdominal scar, and a higher risk of postoperative complications compared with minimally invasive techniques.

Recovery after myomectomy

The recovery period depends on the surgical approach:

1. Laparoscopic myomectomy. Recovery is relatively rapid; most patients return to normal activities within 1–2 weeks. Physical exertion and sexual activity should be avoided for 4–6 weeks.
2. Hysteroscopic myomectomy. Recovery usually takes several days to one week. Daily activities can be resumed quickly, although physical strain and sexual intercourse should be limited for several weeks.
3. Abdominal myomectomy. Full recovery typically requires 4–6 weeks. During this period, patients should avoid heavy physical activity and strictly follow medical recommendations.

Conservative myomectomy aims at preserving the uterus and maintaining reproductive function. In many cases, the procedure restores or improves fertility, particularly when fibroids were the underlying cause of infertility or miscarriage.

However, pregnancy planning is generally postponed for several months after surgery (most commonly 6–12 months) to allow complete healing and restoration of the uterine wall.

Prevention of fibroid recurrence

• Hormonal therapy, when indicated.
• Regular follow-up with a gynecologist, including gynecological examinations and ultrasound monitoring of the uterus.
• A healthy lifestyle with balanced nutrition and moderate physical activity.

Conservative myomectomy is an effective organ-preserving surgical option for the treatment of uterine fibroids, especially for women wishing to maintain fertility. The choice of surgical technique depends on fibroid size, number, and location, as well as the patient’s overall health status. Adherence to postoperative recommendations and regular gynecological follow-up are essential to reduce the risk of recurrence.