If your fibroid symptoms don’t improve with medication, or if your doctor suspects fibroids may be causing infertility, he or she may recommend surgery to remove them. The goal of surgery may be to relieve pain, reduce menstrual blood flow, or improve fertility. NYU Langone surgeons are experts in fertility-sparing fibroid removal, which preserves the uterus and other reproductive organs while maximizing pain relief.
At NYU Langone, our doctors perform four types of surgery to treat fibroids. Factors to consider when choosing a procedure include your lifestyle, future pregnancy plans, and the severity of your symptoms.
Your NYU Langone doctor may recommend uterine fibroid embolization, which blocks blood flow to the fibroids, causing them to shrink. In this minimally invasive procedure, low-dose X-ray images help the doctor guide a thin tube called a catheter through a very small incision in the groin. He or she moves the catheter into the femoral artery in the thigh and then to the uterine arteries that supply blood to the fibroids. The doctor injects the arteries with small synthetic beads that block the blood supply to the fibroids.
Performed using sedation, this procedure may require a one-night hospital stay to control pain after it’s over. Recovery lasts from 3 to 10 days, and you may have a follow-up MRI or ultrasound up to 6 months after the procedure to assess how much the fibroids have shrunk.
Some women are at risk for passing a fibroid through the vagina. This tends to occur with fibroids that are located just beneath the lining inside the uterus. A fibroid may pass any time from several weeks to two years after a uterine fibroid embolization, which can lead to abnormal bleeding, infection, or pelvic pain. Your doctor may recommend removing these fibroids through a hysteroscopy before or after the procedure.
Myomectomy refers to the surgical removal of fibroids. It is used to treat bleeding, infertility, pain, and pressure caused by fibroids. Your NYU Langone surgeon uses one of four procedures to remove the fibroids, depending on their size, number, and location. Because myomectomy preserves the uterus, it may be preferable for women who wish to become pregnant. New fibroids may grow after surgery, however, especially if a woman has multiple fibroids.
In a hysteroscopy, an outpatient procedure, the surgeon inserts a thin, lighted scope through the vagina into the uterus. He or she can diagnose and remove fibroids on the inner wall of the uterus. The procedure can be done using local or general anesthesia; you and your surgeon can decide which is more appropriate for you. The recovery time takes anywhere from one to three days, depending on the number, size, and location of the fibroids.
During a laparoscopy, a lighted scope and other instruments are inserted through small incisions in the abdomen. Performed using general anesthesia, laparoscopy is usually done on an outpatient basis. It requires up to two weeks of recovery, depending on the number, size, and location of the fibroids removed.
During a robotic laparoscopic myomectomy, your NYU Langone surgeon has a high-resolution, three-dimensional view of fibroids and the surrounding tissue, as well as a greater range of motion than with traditional laparoscopy. Because the robot allows for precise movements of surgical instruments, scarring and blood loss can be decreased.
General anesthesia is used during this procedure. You can typically leave the hospital the same day following robotic myomectomy. Recovery can take up to two weeks.
A laparotomy is performed using general anesthesia. The doctor makes an abdominal incision that is several inches long to remove large fibroids, multiple fibroids, or fibroids that have grown deep into the wall of the uterus. This procedure requires a stay of one to three days in the hospital and four to six weeks at home for recovery.
Hysterectomy is the surgical removal of the uterus. It is the only treatment that prevents fibroids from recurring. NYU Langone doctors consider hysterectomy a last-resort treatment for women who do not wish to preserve their fertility. It is usually recommended for women with fibroids that cause pain and menstrual bleeding that interfere with daily life. In rare situations, hysterectomy is recommended for women with fibroids that grow after menopause. Your doctor can help you decide whether this procedure is appropriate for you.
Hysterectomy can be performed in several ways, depending on the size, number, and location of the fibroid or fibroids. It can be done via open surgery; laparoscopy, in which a lighted scope and other instruments are inserted through small abdominal incisions; robotic laparoscopy; or vaginal surgery, in which the uterus is removed through the vagina.
A hysterectomy can require an overnight hospital stay for less invasive surgeries or a three-day stay for open surgery. Recovery time is typically up to two weeks for minimally invasive surgery and up to six weeks for open surgery.
Endometrial ablation, destruction of the lining of the uterus, can control or eliminate heavy menstrual bleeding. There are several approaches to the procedure. Sometimes doctors use a wand to freeze the lining of the uterus. Heat also may be used: heated fluid or a balloon filled with heated saline can erode the uterine lining. Alternatively, your surgeon may use an electrical current, radiofrequency energy (an electrical current produced by radio waves), or microwave energy to destroy the uterine lining.
After the procedure, some women experience cramping, nausea, or a watery or slightly bloody discharge; these problems typically last one to two weeks. Endometrial ablation is done on an outpatient basis using a local or spinal anesthesia. Recovery can take two days to two weeks, depending on the number, size, and location of the fibroids.
Because endometrial ablation affects the uterine lining, which is necessary for fertility, doctors do not recommend it for those who wish to become pregnant.