Approaches Based on Fibroid Location

• Intramural (inside the wall): Often requires a laparoscopic or abdominal approach.

• Subserosal (on the outer surface): Usually removed via laparoscopy.

• Submucosal (bulging into the cavity): Removed via Hysteroscopic Myomectomy, which involves no incisions.

Surgical Nuance

The surgeon must carefully reconstruct the uterine wall after removing the fibroid to ensure it is strong enough to hold a future pregnancy. This requires “multi-layer suturing.” Because of this, women who have had a deep myomectomy are usually advised to deliver via Planned C-section to avoid the risk of uterine rupture during labor.