Surgical management of uterine fibroids may be necessary for women who experience severe symptoms, such as pressure symptoms or heavy uterine bleeding or complications such as infertility, miscarriage, or preterm labor. There are several surgical options available, each with its own benefits and risks. 

Myomectomy is a surgical procedure that involves removing the fibroids while leaving the uterus intact. This is an option for women who wish to preserve their fertility or who want to avoid a hysterectomy. Myomectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. The minimally invasive approach is preferred due to faster recovery times and less risk of complications. The downsides of a myomectomy are the risk of recurrence of fibroids (approximately 50%) and about 20% of women who have a myomectomy end up needing another surgical intervention due to fibroids later in life. 

Hysterectomy is the surgical removal of the uterus and is the only definitive cure for uterine fibroids. It may be recommended for women who have completed childbearing or who have severe symptoms that have not responded to other treatments. Hysterectomy can be performed through an abdominal incision or minimally invasive laparoscopic or robotic surgery. Here again, the minimally invasive approach is preferred. 

Endometrial ablation is a minimally invasive procedure that destroys the lining of the uterus, which can reduce heavy menstrual bleeding caused by uterine fibroids. This option is only recommended for women who do not wish to have children in the future. 

 Uterine artery embolization (UAE) is a non-surgical procedure that blocks the blood supply to the fibroids, causing them to shrink. This option is not recommended for women who wish to preserve their fertility or who have fibroids that are too large or numerous. 

 Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive procedure that uses focused ultrasound waves to destroy the fibroids. This option is only available at select medical centers and is not recommended for women who wish to preserve their fertility. 

 The choice of surgical management for uterine fibroids depends on several factors, including the size and location of the fibroids, severity of symptoms, and desire for future fertility.