A mini-laparotomy myomectomy removes fibroids through a small bikini-line incision while keeping the uterus. It suits large, numerous, or deep fibroids that are hard to remove fully with a laparoscope. The incision is only 4–5 cm, and recovery is about the same as laparoscopic or robotic surgery and faster than a traditional open myomectomy, which uses a much longer incision. Peyman Banooni, MD, performs mini-laparotomy myomectomy for patients in Beverly Hills and across Los Angeles.
If you have large or many fibroids, you may have been told your only choices are a big abdominal incision or a hysterectomy. There’s another option. A mini-laparotomy myomectomy removes fibroids through a small incision, usually hidden at the bikini line, and leaves the uterus in place.
Beverly Hills gynecologic surgeon Peyman Banooni, MD, uses this approach to remove fibroids that are too large or too numerous for other minimally invasive techniques, with the same recovery as laparoscopic or robotic surgery, less operating time, and a single, more cosmetically appealing incision.
What is a mini-laparotomy myomectomy?
A myomectomy is surgery that removes fibroids and repairs the uterus. A traditional open myomectomy uses a long incision. A mini-laparotomy uses a much smaller one, typically 4–5 cm (about 2 inches) long, placed low on the abdomen where it’s easy to hide.
Through this opening, the surgeon can see and feel the uterus directly. That allows careful removal of fibroids, including small ones that might not show up on imaging, and a strong, layered repair of the uterine wall.
Who is a good candidate?
Mini-laparotomy myomectomy is often recommended for people who:
- Have large fibroids, or many fibroids in different locations
- Have fibroids deep in the uterine wall (intramural) or on the outer surface (subserosal)
- Want to keep their uterus, including for future pregnancy
- Have symptoms such as heavy bleeding, pressure, or bloating that medication hasn’t controlled
- Prefer to have fibroids removed rather than shrunk
Fibroids inside the uterine cavity are usually better treated through the cervix with hysteroscopic myomectomy. Imaging with ultrasound or MRI helps Dr. Banooni decide which approach fits your fibroids.
Why remove fibroids rather than shrink them?
According to a 2024 New England Journal of Medicine review, most guidelines favor surgically removing fibroids, rather than shrinking them, for people who want to optimize fertility. That’s because surgeons have long experience with myomectomy and its effect on later pregnancy.
Myomectomy is also the usual choice when fibroids are so large that shrinking them wouldn’t bring enough relief.
How it compares with other fibroid surgery
| Feature | Mini-laparotomy myomectomy | Laparoscopic myomectomy | Traditional open myomectomy |
|---|---|---|---|
| Incision | One small bikini-line incision | Several small incisions | One long incision |
| Best for | Large or multiple fibroids | Fewer, smaller fibroids | Very large uterus |
| Surgeon can feel the uterus | Yes | No | Yes |
| Typical hospital stay | Same day to 1 night | Same day | 2–3 nights |
| Typical return to normal activity | About 2 weeks | About 2 weeks | About 4–6 weeks |
Recovery times vary from person to person. Dr. Banooni will give you a plan based on your health and the extent of your surgery.
What to expect
- Before surgery: You’ll have imaging, often an ultrasound or MRI, to map your fibroids. If you’re anemic, you may take iron or a short course of medication first to build up your blood count.
- During surgery: The procedure is done under anesthesia. Dr. Banooni removes each fibroid and closes the uterine wall in layers.
- Afterward: Many patients go home the same day or the next morning. Walking soon after surgery helps recovery. Most people return to desk work in about 2 weeks.
- Follow-up: You’ll have a post-operative visit to check healing and talk about next steps, including timing for pregnancy if that’s your goal.
Pregnancy after myomectomy
Many people conceive after myomectomy. Your surgeon will usually advise waiting a few months for the uterus to heal before trying. Because the uterine wall has been repaired, a cesarean birth is often recommended, which is something to plan with your obstetrician.
Risks and fibroid recurrence
Like any surgery, mini-laparotomy myomectomy has risks, including bleeding, infection, scar tissue, and rarely the need for a transfusion. Dr. Banooni will review these with you.
New fibroids can also grow. Research shows about half of people develop new fibroids within 5 years of myomectomy, though many never cause symptoms, especially as menopause approaches.
Mini-laparotomy myomectomy with Dr. Banooni
Peyman Banooni, MD, is a board-certified OB-GYN and gynecologic surgeon in Beverly Hills. He performs mini-laparotomy myomectomy for patients from Beverly Hills, West Hollywood, Santa Monica, Burbank, and throughout Los Angeles, with a focus on preserving the uterus and fertility.
Schedule a myomectomy consultation with Dr. Peyman Banooni in Beverly Hills. Call (310) 652-9347 or request a consultation online.
Frequently asked questions
How big is the incision for a mini-laparotomy myomectomy?
The incision is typically 4–5 cm (about 2 inches) and placed low on the abdomen near the bikini line, much smaller than a traditional open myomectomy incision and often more cosmetically appealing than several laparoscopic incisions.
How long is recovery after a mini-laparotomy myomectomy?
Many patients go home the same day or next day and return to normal activities in about 2 weeks, the same recovery as laparoscopic or robotic myomectomy. Recovery depends on the number and size of fibroids removed.
Is mini-laparotomy myomectomy better than laparoscopic myomectomy?
It depends on your fibroids. Recovery is about the same, with less surgical time and one 4–5 cm incision instead of several. Mini-laparotomy is often better for large or numerous fibroids, while laparoscopy suits fewer, smaller ones. Your surgeon can recommend the best fit based on imaging.
Can I get pregnant after a myomectomy?
Yes, many people do. Most surgeons advise waiting a few months before trying, and a cesarean birth is often recommended afterward.
Who performs mini-laparotomy myomectomy in Los Angeles?
Peyman Banooni, MD, a board-certified OB-GYN and gynecologic surgeon in Beverly Hills, performs mini-laparotomy myomectomy for patients across Los Angeles.
Related articles
- Uterine Fibroid Treatment in Los Angeles: Your Options Beyond Hysterectomy
- Hysteroscopic Myomectomy in Los Angeles
Sources
- Stewart EA, Laughlin-Tommaso SK. Uterine Fibroids. New England Journal of Medicine 2024;391:1721–33.
- American College of Obstetricians and Gynecologists. Management of Symptomatic Uterine Leiomyomas. Practice Bulletin No. 228, 2021.
This article is for general education and is not medical advice. Talk with your healthcare provider about your symptoms and treatment options.
Peyman Banooni, MD, FACOG, is a board-certified obstetrician-gynecologist and gynecologic surgeon in Beverly Hills, California, serving patients across Los Angeles. He treats uterine fibroids with medication and uterus-sparing surgery, including hysteroscopic myomectomy and mini-laparotomy myomectomy. Dr. Banooni earned his bachelor’s degree in biology from UCLA with summa cum laude honors and is a surgeon at Cedars-Sinai Medical Center. FACOG means he is a Fellow of the American College of Obstetricians and Gynecologists.
Office: 150 N Robertson Blvd, Suite 200, Beverly Hills, CA 90211 · Phone: (310) 652-9347 · Website: fibroid-treatment.com