- Cavity-based fibroids → hysteroscopy; most others → laparoscopy.
- Keyhole can handle large fibroids in experienced hands.
- Open surgery is now a specific choice, not a default.
Hysteroscopic myomectomy
Used for submucosal fibroids inside the uterine cavity. A thin scope is passed through the cervix — no incisions on the abdomen. Recovery is usually 24–48 hours, and the impact on fertility is highly favourable. Suitable for fibroids up to around 4–5 cm depending on cavity depth.
Laparoscopic (keyhole) myomectomy
The standard technique for subserosal and intramural fibroids. Three or four small incisions, magnified visualisation, precise reconstruction of the uterine wall. In expert hands, multiple large fibroids can be removed laparoscopically — the myth that keyhole surgery only works for small fibroids is outdated.
Recovery: back to light activity in 7–10 days, full activity in 4–6 weeks. Hospital stay typically 1–2 nights.
Open (abdominal) myomectomy
Reserved for very large fibroid burdens, extensive scarring from previous surgery, or when laparoscopic access is unsafe. A bikini-line or lower midline incision provides direct access. Recovery is longer — 6 weeks off heavy activity — but the operation itself is highly effective.
How the choice is made
The decision is made together after a detailed MRI or specialist scan showing fibroid number, size and location. Any surgeon who quotes only one technique regardless of anatomy is not giving you the full picture — ask why.
Frequently asked questions
Can very large fibroids be done keyhole?
Yes — fibroids up to 15–20 cm can be removed laparoscopically with experienced surgery, though the operation is longer.
Is robotic surgery better than laparoscopic?
For most fibroid work the outcomes are equivalent; robotic surgery adds cost but not always benefit.
Can I choose which technique?
You choose with your surgeon — anatomy limits some options, but expertise widens them.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your imaging and giving you a clear personalised plan for uterus-sparing fibroid surgery.
Request a video consultation