Advances in Uterine Fibroid Management: Myomectomy Techniques and Training


Uterine fibroids, also known as leiomyomas or myomas, are benign tumors that grow within or on the walls of the uterus. There are several different types of fibroids based on their location. The most common type is the intramuscular fibroid, which grows within the myometrium or middle layer of the uterine wall. Submucosal fibroids develop just beneath the lining of the uterus and can cause heavier menstrual bleeding. Subserosal fibroids form on the outside of the uterus and can grow quite large. Finally, pedunculated fibroids grow on stalk-like structures attached to the uterus.

Fibroids often do not cause symptoms but when they do, common complaints include heavy or prolonged menstrual bleeding, pelvic pressure or pain, urinary frequency or urgency, difficulty emptying the bladder, painful intercourse, lower back pain, and bloating or swelling of the abdomen. The symptoms experienced depend on the size, number and location of the fibroids. Larger tumors are more likely to create pressure on surrounding organs.

Surgical and Non-Surgical Treatment Options

The treatment chosen depends on the severity of symptoms, size and number of fibroids, age and plans for future fertility. Watchful waiting with over-the-counter pain medication may be recommended for small, asymptomatic fibroids. Non-surgical options include medication such as birth control pills, progestin therapy, or gonadotropin-releasing hormone (GnRH) agonists to temporarily induce menopause-like symptoms.

For fibroids causing heavy bleeding or pain, a hysterectomy (surgical removal of the uterus) is often performed but eliminates the possibility of future pregnancy. Myomectomy aims to conserve fertility by removing only the fibroids while keeping the uterus intact. Originally an open surgical procedure, myomectomies can now be performed using minimally invasive techniques such as laparoscopy or hysteroscopically through the cervix. Advantages of minimally invasive approaches include smaller incisions, less pain, quicker recovery times and fewer complications compared to open surgery. However, they may not be suitable for large or deep fibroids. Radiofrequency ablation uses heat to destroy fibroid tissue but is best for smaller tumors. Ultrasound-guided focused ultrasound targets fibroids with sound waves, causing them to shrink without surgery.

Use and Efficacy of Myomectomy Worldwide

According to the World Health Organization, fibroid-related procedures account for approximately one-third of all hysterectomies performed globally each year. Hysterectomy has long been the standard treatment but trends are shifting toward uterine-sparing options like myomectomy that avoid infertility and menopausal side effects of removing the entire uterus.

A 2021 study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology reviewed data on fibroid-related surgeries from over 70 countries. It found that while hysterectomy remains the most common treatment worldwide, the rate of myomectomies is steadily increasing in both developed and developing nations. Countries with the highest rates of myomectomy included the United States, Canada, Italy, France, Japan and South Korea. Use of minimally invasive techniques like laparoscopic myomectomy has grown significantly in recent decades, now representing over half of procedures in some regions.

Safety and effectiveness of fibroidectomy depends on factors like surgeon experience and technique used. Published success rates for symptom relief after open abdominal, laparoscopic and hysteroscopic fibroidectomy range from 70-95% depending on individual studies. Recurrence of fibroids after surgery occurs in 20-40% of women within 5 years but may be lower with complete removal of all visible tumors. Pregnancy rates following myomectomy are approximately 65-80% for those attempting to conceive, influenced by patient age, size and location of fibroids removed. Overall, fibroidectomy is shown to improve quality of life by eliminating or reducing fibroid symptoms and preserving reproductive function for those who desire future childbearing.

Global Myomectomy Training Programs

As access to advanced gynecological care expands worldwide, so does demand for skilled surgeons trained in fibroid-removal techniques. Several international organizations now offer comprehensive fibroidectomy training programs to build surgical capacity globally.

The American Association of Gynecologic Laparoscopists (AAGL) hosts an annual Global Endosurgery Fellowship that provides intensive, hands-on laparoscopic fibroidectomy training to gynecologists from all regions. Fellows gain experience in techniques such as suturing, hemostasis and colpotomy closure under mentorship of AAGL-accredited master surgeons. Over 500 physicians from more than 50 countries have participated, helping to establish advanced laparoscopy as the gold standard for fibroid treatment in their home institutions.

In Europe, the European Association of Gynaecological Endoscopic Surgery (EAGLES) founded a similar fellowship program in 2018 focused on laparoscopic and hysteroscopic procedures including fibroidectomy. Available to surgeons throughout the European continent, it aims to standardize advanced surgical skills and knowledge transfer.

Several individual medical centers are also spearheading myomectomy training initiatives. For example, a tertiary hospital in India launched a comprehensive fibroidectomy workshop series to equip local specialists with expertise in laparoscopic approaches, reducing reliance on open abdominal surgery. Such programs are strengthening uterine fibroid management globally by increasing surgical expertise worldwide.

1.  Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it