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Open myomectomy

Symptomatic fibroids in a woman wishing to keep her uterus.

Source: Standard operative texts

Steps

  1. Optimise Hb (iron ± GnRH analogue); cross-match; consider cell salvage.
  2. Reduce bleeding: vasopressin or tourniquet / Bonney’s myomectomy clamp.
  3. Fewest incisions possible, ideally anterior midline.
  4. Find capsule plane; grasp with myoma screw/vulsellum and enucleate.
  5. Avoid entering the cavity where possible.
  6. Close dead space in layers; close serosa; consider adhesion barrier.
Risks: haemorrhage, transfusion, conversion to hysterectomy, adhesions, scar rupture in pregnancy — consider planned CS if the cavity was opened.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.