Laparoscopic myomectomy

Summary

A laparoscopic myomectomy is a keyhole operation to remove fibroids — non-cancerous growths of the womb muscle — while keeping your womb. Fibroids are very common (around 1 in 4 women develop them), and surgery is considered when they cause heavy bleeding, pain, pressure or fertility problems that simpler treatments have not controlled.

• The operation is done through 3–4 small cuts, the largest about 1 cm, under general anaesthetic.
• Because the womb is kept, pregnancy remains possible — this is the operation's main purpose compared with hysterectomy.
• You can usually be up and about the same day, and go home the following day.
• Bleeding and later adhesions (internal scar tissue) are much less likely than with open surgery — important if you are planning a pregnancy.
• There is no fixed size limit: the operation is usually done by the keyhole route, with open surgery reserved for selected cases.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

A myomectomy removes fibroids and repairs the womb, unlike a hysterectomy, which removes the womb itself. In the laparoscopic (keyhole) approach, a thin camera (laparoscope) is passed through a cut near the navel and the surgeon operates with fine instruments through the other small cuts, watching a screen.

Each fibroid is freed from the womb muscle and the womb wall is then repaired with stitches. Because the cuts are small, a fibroid usually has to be divided into smaller pieces to be taken out — this is called morcellation.

The concern with morcellation is that if a fibroid contained an unsuspected cancer, dividing it inside the abdomen could spread cells. This is rare, but taken seriously, so our practice is:

• In-bag morcellation — the fibroid is placed inside a specimen bag before it is divided, so the tissue stays contained.
• Direct morcellation in selected cases, where the pre-operative assessment and the appearance at surgery indicate a benign fibroid.

Your surgeon will explain which approach is planned for you, and why, based on your scan findings.

There are two related operations your consultant may discuss instead, depending on your scan:

• Hysteroscopic resection — small fibroids bulging into the womb cavity can be removed through the cervix with no abdominal cuts at all.
• Open myomectomy — through a larger cut; reserved for selected cases where the keyhole route is not the safer option.

Why it is performed

Fibroids need treatment only when they cause problems. A myomectomy is considered when:

• Heavy or painful periods have not responded to medicines or the hormonal coil
• Pressure symptoms — bloating, urinary frequency or discomfort from larger fibroids
• Fertility problems or recurrent miscarriage where fibroids distort the womb cavity
• You want to keep your womb — whether for a future pregnancy or by personal preference

Your scan shows the number, size and position of the fibroids, and this decides whether the laparoscopic route is suitable for you — see "Preparing for surgery" below.

Benefits

• Symptoms improve with the womb kept — bleeding, pain and pressure usually improve once the fibroids causing them are removed.
• Pregnancy remains possible. For women hoping to conceive, the keyhole route also causes fewer adhesions around the womb, tubes and ovaries than open surgery — one of its main advantages.
• Compared with open myomectomy: much less bleeding, less pain, tiny scars, a shorter stay and a faster return to normal life.

Be aware: new fibroids can grow over time, so symptoms can return years later — a myomectomy treats the fibroids you have now, not the tendency to form them.

Alternatives

• No treatment now. Fibroids that cause no or mild symptoms can simply be monitored; they usually shrink after menopause.
• Medicines — hormonal and non-hormonal treatments that reduce bleeding, and drugs that temporarily shrink fibroids.
• The hormonal coil (LNG-IUS) — often effective for bleeding when the womb cavity is not distorted.
• Hysteroscopic resection — for small fibroids inside the cavity, removed through the cervix with no cuts.
• Uterine artery embolisation (UAE) — a radiology procedure that shrinks fibroids by blocking their blood supply. It is not widely available in Sri Lanka, and suitability depends on your case and fertility plans.
• Hysterectomy — the definitive treatment when your family is complete, now also possible by keyhole — see our laparoscopic hysterectomy guide.

Preparing for surgery

Every woman having a myomectomy has ultrasound imaging — both abdominal and transvaginal — as a matter of routine. This shows how many fibroids there are, how big they are, exactly where they sit in the womb wall, and whether their appearance is reassuring; that assessment determines the surgical approach recommended and how the tissue will be removed. You will also have a physical examination, blood tests (anaemia from heavy bleeding is corrected first where possible), blood pressure checks, and a review of your medicines and general health. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery or anaesthetic problems.

• Smoking: stopping even a few weeks before surgery reduces chest and wound complications.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange for someone to take you home; plan to avoid heavy lifting in the first weeks.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including what should happen if unexpected findings are encountered. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is done under general anaesthetic — you are fully asleep and feel nothing. The abdomen is gently inflated with carbon dioxide gas to create working space, and the laparoscope and instruments are introduced through the small cuts.

Working with fine instruments on a magnified view, the surgeon opens the womb muscle over each fibroid, frees it, and repairs the womb in layers with dissolvable stitches — this careful, unhurried technique is what keeps blood loss low and protects the surrounding organs. The fibroids are then divided into strips within a containment system and removed through the 1 cm port. How long the operation takes depends on the number and size of fibroids — commonly 1 to 2 hours.

Occasionally, if keyhole surgery proves unsafe to continue — for example because of bleeding or unexpected findings — the surgeon completes the operation through a larger cut for your safety. This is uncommon.

After the operation

You will wake in the recovery room. Some shoulder-tip pain is common for a day or two — it comes from the gas used during surgery and settles on its own.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• Eating and drinking: usually the same day, starting with fluids.
• Moving: you can usually be out of bed and doing normal light activity the same day — early walking speeds recovery and protects against clots.
• Going home: usually the following day.
• Bleeding: light vaginal bleeding or spotting for a few days to weeks can be normal.

Recovery at home

• Week 1: rest with gentle activity — short walks, light lifting is fine. Tiredness is normal.
• Week 2 onwards: most women are back to normal activity and routine work; build up steadily as you feel able.
• Driving: usually after about 2 weeks — when you can wear a seatbelt comfortably and perform an emergency stop without hesitation. Check your insurer's policy.
• Strenuous exercise and heavy physical work: usually from 3–4 weeks, guided by comfort.
• Follow-up: attend your follow-up appointment so your recovery and the womb repair can be checked.
• Trying for a pregnancy: the womb repair needs time to heal — the standard advice is to wait 6 months before trying to conceive. Depending on how deep the repair was, a planned caesarean may be advised for a future birth; ask what applies to you.

These are typical figures for keyhole surgery; your own advice may differ and comes first.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on the number, size and position of your fibroids, your health and previous surgery, and will be discussed with you.

Expected, temporary effects

• Pain and tiredness in the first days; shoulder-tip pain from the gas for a day or two
• Light vaginal bleeding or spotting
• Bruising around the small cuts

Complications

• Bleeding — the womb has a rich blood supply; bleeding heavy enough to need a transfusion is uncommon, and much less likely than with open myomectomy.
• Infection — of the urine, chest or wounds; most cases minor and settled with antibiotics (uncommon).
• Injury to the bladder, bowel or ureters — recognised injuries are repaired (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Conversion to open surgery during the operation, for safety (uncommon).
• Hysterectomy during the operation — in theory, uncontrollable bleeding could make removing the womb the only safe option. This has almost never been necessary in Dr Mathota’s myomectomies, but it is discussed with you before consent.
• Fibroid recurrence — new fibroids can form over the years; some women need further treatment later.
• Scar on the womb — the repair leaves a scar that matters in future pregnancy and birth planning (see recovery section).
• Anaesthetic risks — serious anaesthetic complications are rare in otherwise healthy women.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• A wound that becomes red, swollen, hot or leaks fluid
• Burning on passing urine, or being unable to pass urine
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this operation is recommended for you, what the realistic alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline NG88. Available from: https://www.nice.org.uk/guidance/ng88 [last checked 28 July 2026].
2. National Health Service (UK). Fibroids — treatment. Available from: https://www.nhs.uk/conditions/fibroids/treatment/ [last checked 28 July 2026].
3. Royal College of Obstetricians and Gynaecologists. Morcellation for myomectomy or hysterectomy — information for you. London: RCOG. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 28 July 2026].
4. Royal College of Obstetricians and Gynaecologists. Patient information — browse all. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 28 July 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Laparoscopic myomectomy: removing fibroids, keeping your womb. Available from: https://sugabi.lk/blog/115/…
2. Sugabi Clinic Ragama. Uterine fibroids: symptoms, diagnosis and treatment options. Available from: https://sugabi.lk/blog/1142/…
3. vog.lk — Laparoscopic Myomectomy සැත්කම ගැන දැන ගන්න (Sinhala, by Dr Chaminda Mathota). Available from: https://vog.lk/678-myomectomy.php
4. vog.lk — ලැපරොස්කොපි සැත්කම් සිදු කරන හැටි (Sinhala). Available from: https://vog.lk/735-laparoscopic_surgery.php