Myomectomy: an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Myomectomy in one minute
What it is: surgery to remove fibroids from the womb while keeping the womb.
Who it is for: people with symptomatic fibroids who want to keep their womb, often to try for pregnancy.
Main risks: bleeding (sometimes heavy), infection, adhesions, fibroids coming back, rarely hysterectomy.
Usually: under general anaesthetic, 1–3 hours, home in 1–4 days.
On this page: What is a myomectomy? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is a myomectomy?
Fibroids are non-cancerous growths of the muscle of the womb. They can cause heavy periods, pain, pressure or fertility problems.
In a myomectomy the surgeon:
- opens the womb muscle over each fibroid and shells it out
- repairs the womb wall in layers
- uses methods to reduce bleeding, such as medicines or a tourniquet, as per centre protocol
The route can be open (laparotomy), laparoscopic, or hysteroscopic (through the cervix, for fibroids inside the cavity), per surgeon.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- symptomatic fibroids in people who wish to keep their womb
- fibroids affecting fertility, after specialist assessment
The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
Most operations are planned; some are urgent. Before it, you usually have:
- an ultrasound or MRI scan
- blood tests, including blood count and group and save or crossmatch
- sometimes medicines to shrink fibroids or treat anaemia before surgery
- a review of your medicines, as per centre protocol
- a chance to ask questions and give consent, including the small chance of hysterectomy
Step by step
1. Getting ready
Team brief and WHO checklist first. The anaesthetic team and ODP give the anaesthetic (general, regional or local, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning, pressure areas, the diathermy plate and warming. The scrub practitioner sets up the instrument trolley and does the first count. A urinary catheter is placed; cell salvage may be set up, per centre.
2. Access
Often a low horizontal cut (open myomectomy), or ports for laparoscopic surgery.
3. Removing the fibroids
- A. Fibroid found. The fibroids are located by sight and touch.
- B. Womb opened. A cut is made in the womb muscle over the fibroid, with bleeding reduced as per centre protocol.
- C. Fibroid removed. The fibroid is shelled out.
- D. Wall repaired. The womb wall is closed in layers.
4. Finishing
An anti-adhesion barrier may be used, per surgeon. The abdomen is closed in layers. Final counts are confirmed, specimens labelled and checked, and the patient goes to recovery with a full handover.
Recovery and aftercare
- First hours: in recovery, then a ward or day unit; pain relief and anti-sickness medicine.
- Going home: often 1–4 days.
- Activity: walking early; avoid heavy lifting for about 6 weeks; ask your team.
- Bleeding: some vaginal bleeding or discharge is common for a short time.
- Sex and driving: ask your team when it is safe.
- Follow-up: results and review, as per centre protocol.
- Pregnancy: your team will advise how long to wait and how to give birth in future.
Call 999 if you have heavy bleeding, severe pain, breathlessness, chest pain or collapse. Contact your team or GP if you have a fever, smelly discharge, pain or swelling in a leg, or a wound that becomes red, hot or leaky.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- bleeding, sometimes needing transfusion
- infection
- adhesions
- fibroids coming back
- hysterectomy if bleeding cannot be controlled (rare)
- injury to the bladder or bowel (rare)
- blood clots in the legs or lungs
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- major gynaecology instrument set and self-retaining retractor
- myoma screw and tenaculum, per surgeon
- medicines to reduce bleeding, as per centre protocol
- uterine tourniquet, per surgeon
- sutures for layered repair
- cell salvage, per centre
- laparoscopic stack and ports if keyhole
- closure sutures and dressings
Procedural steps
- Team brief, WHO sign in; blood availability; anaesthesia
- Catheter; prep and drape; count
- Incision or ports; fibroids located
- Bleeding control; womb opened; fibroids removed
- Layered repair; adhesion barrier if used
- Closure; counts; specimen check; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
- Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
- Blood ready. Know the blood availability and cell salvage plan before the start.
- Measure blood loss. Weigh swabs and measure suction.
- Specimens. Label every specimen and check it before it leaves theatre.
FAQ
Can fibroids come back?
Yes, new fibroids can grow.
Can I get pregnant afterwards?
Often yes; your team will advise on timing and birth plans.
Is it keyhole?
Sometimes, depending on size and number of fibroids.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- NHS. Fibroids. nhs.uk/conditions/fibroids
- NICE. Heavy menstrual bleeding: assessment and management (NG88). nice.org.uk/guidance/ng88
- StatPearls (NCBI Bookshelf), search: myomectomy. ncbi.nlm.nih.gov/books
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
