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 50%%. These myoma 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 and abnormal uterine bleeding (AUB ), 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 most common treatment for women who do not desire future pregnancy and who have symptomatic uterine fibroids has been hysterectomy (removal of a womans uterus). If a woman wishes to maintain her fertility, or s desires a uterine sparing technique rather than hysterectomy, , then an alternative procedure involves an abdominal myomectomy. Both of these techniques major surgery, and both involve making a large abdominal incision (laparotomy), with a 2-4 day hospital stay, large permanent abdominal scar, greater post-operative pain and discomfort, and a 6-8 week recovery.
Newer developments in the field of minimally-invasive laparoscopic & hysteroscopic surgery now allow many gynecologic surgeons to perform these procedures using either no incisions or very small (1/2 inch) incisions in the abdominal wall. With RadioFrequency Thermal Ablation (see below), no uterine incision(s) are needed. Advantages of these newer techiques are: ambulatory surgery (patients go home the same day), more rapid recovery (days rather than weels), far smaller or no visible incisions,significantly reduced post-operative pain, and areduced 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. I have been using and helping to develop these advanced techniques in my practice since 1989.
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 womans cervical canal, and does not require an incision into the abdomen. A device called an operative hysteroscope 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 most recent new technology released in 2011 is MyoSure (Hologic, Inc), which allows gynecologic surgeons to rapidly and more safely remove either fibroids or polyps in the uterine cavity with either local or general anesthesia. Hysteroscopic resection procedures generally take less than 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.
RadioFrequency Volumetric Thermal Ablation technology is a less invasive laparoscopic technique currently undergoing clinical trials in the United States and Latin America (I am one of the Principal Investigators with this new (2011) technology). This surgery takes place with the woman under general anesthesia. Using two 1/2 inch incisions in the abdomen, and with a combination of laparoscopic intra-abdominal ultrasound and video cameras , we are able to clearly view the interior of the womans abdomen and pelvis and can see into and through her uterus to determine the precise location and size of any fibroid(s).Then using RadioFrequency Thermal Ablation technology (Halt Medical, Inc.), fibroid(s) can be ablated without the need for any uterine incisions. This technology is currently under Investigational Use only in the United States, and may be available in 2012. As with other forms of myomectomy, there is the possibility that fibroid(s) may recur, or that new fibroids may develop.
Numerous medical
articles and publications have demonstrated advantages to patients using
minimally-invasive techniques of laparoscopy or hysteroscopy, which include
returning home the same day, smaller or no abdominal or uterine incisions, less
pain, a faster recovery, and fewer complications. Costs are also generally lower
than with traditional open abdominal surgery.
Copyright 2000-2011 Donald I. Galen, M.D., FACOG
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