Many women have benign tumors in their uterus called fibroids. Of the 700,000 hysterectomies performed annually in the United States, fibroids are an indication in about 25%. These myoma (fibroids) may be silently present for many years without causing any difficulty. In other women, the presence and location of fibroids can cause various symptoms, including excessive menstrual bleeding, frequent and painful menses, anemia from chronic blood loss, a sensation of abdominal fullness or pressure, discomfort or pain with sexual intercourse or with bowel movements, or pain with activities. Other women may experience infertility problems (difficulty in becoming pregnant, or frequent miscarriages) associated with the presence of uterine fibroids.

The common treatment for women who do not desire a future pregnancy and who have symptomatic fibroids has been a hysterectomy (removal of a womanÕs uterus). If a woman wishes to maintain her fertility, or simply does not wish to have her uterus removed, then an alternative technique involves an abdominal myomectomy. Both of these techniques involve major surgery, and both involve making a large abdominal incision (laparotomy), with a 3-5 day hospital stay, large permanent abdominal scar, significant post-operative pain and discomfort, and a 6-8 week recovery.

Newer developments in the field of minimally-invasive laparoscopic & hysteroscopic surgery now allow certain surgeons with advanced training to perform these same surgical procedures using either no incisions or very small (1/2 inch) incisions in the abdominal wall. Some advantages of these newer techiques are: -ambulatory surgery (patients go home the same day) -more rapid recovery (days rather than months) -far smaller or no visible incisions (better cosmetically) -significantly reduced post-operative pain -reduced risk of post-operative adhesions and other complications

A description of the various newer and minimally-invasive techniques for removing or reducing uterine fibroids (myomata uteri) follows. We have been using these advanced techniques virtually exclusively in our practice for our patients since 1989. In fact, we seldom need to employ an open abdominal surgical approach in any patient.

Hysteroscopic Resection of Fibroids

Hysteroscopic resection or myomectomy is an ambulatory procedure, and can take place both with the patient awake (regional anesthesia) or with her asleep (general anesthesia). This procedure is performed through the womanÕs cervical canal, and does not require an incision into the abdomen. A device called a resectoscope is used to remove the fibroid(s) present within the uterine cavity while viewing the surgical site via a tiny high-resolution color camera. The primary surgical risk of this procedure (according to the medical literature), has been the risk of fluid overload, which can be life-threatening. We have never experienced this complication in our practice. We have, in fact, recently converted all of our operative resectoscopes to use the new Conceptus ERA bipolar sleeve, which now allows us to employ normal saline rather than the more potentially-harmful sorbitol, mannitol or glycine as used in other centers. This should further reduce or eliminate the risk of fluid overload for our patients. Hysteroscopic resection procedures generally take about one hour to perform, and the woman can go home within 1-2 hours after completion of the procedure. In most cases, she is back to near-normal activities within 1-2 days.

Laparoscopic Myomectomy and Laparoscopic Myolysis

Laparoscopic fibroid removal (myomectomy) has been the preferred technique in our practice since 1989. This surgery takes place with the woman under general anesthesia. Using several small 1/2 inch incisions in the abdomen and videolaparoscopy, we are able to clearly view the interior of the womanÕs abdomen and pelvis. Then using various techniques, incuding the argon beam coagulator, electrosurgery, ultrasonic surgery, or laser, the fibroid(s) can be removed and the uterine wall repaired. In some situations, it may not be technically possible to safely remove the fibroid(s) because of their proximity to major blood vessels. In these situations, and to avoid making a large incision into the uterine wall, a technique called myolysis can be employed. This newer technology involves the placement of the Galen Myolysis Bipolar Needle into the fibroid(s), and using electrosurgery, the fibroids are destroyed and their blood supply reduced and/or eliminated. This results in a 50% reduction in size of the fibroids following surgery. The myolysis procedure reduces the risk of bleeding during surgery and is a more rapid procedure as compared to myomectomy. It is a more recent addition to our surgical techniques (since 1994) and there are fewer long-term outcome reports available. As with other forms of myomectomy, there is the possibility that the fibroid(s) may eventually recur, or that new fibroids may grow.

Proven Technology or Experimental Techniques?

Our experience, and that of many other advanced laparoscopic surgeons in the United States, has demonstrated the safety and effectiveness of these newer minimally-invasive techniques. Although some insurance companies may still consider these less invasive techniques to be ÒexperimentalÓ and decline insurance coverage, these new techniques are the cutting-edge standard of care in our practice. The proven advantages to our patients include returning home the same day, less pain, a faster recovery, and fewer complications. Costs are also generally lower than with traditional open abdominal surgery.

If you would like further information regarding these alternatives to hysterectomy, please contact us and we will be happy to set up a consultation to review your specific medical situation and needs.

For additional information and resources on fibroids, visit the web sites of the following organizations:

RESOLVE, Inc. American College of Obstetricians and Gynecologists American Society for Reproductive Medicine Endometriosis Association

Copyright 2000-2005 Donald I. Galen, M.D. 
Physician partner in the Reproductive Science Centerª of the San Francisco Bay Area
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