Endoscopic management of uterine fibroids
ABSTRACT Uterine fibroids are the most common benign tumours of the uterus. Management depends on the symptoms, location and size of the fibroids, and the patient's desire to conceive. Surgical management of uterine fibroids has changed from laparotomy to minimally invasive surgery. Uterine fibroids are usually asymptomatic and do not require treatment. Laparoscopic myomectomy is the best treatment option for symptomatic women with uterine fibroids who wish to maintain their fertility. The authors' criteria for laparoscopic myomectomy are a fibroid of <15 cm in size, and no more than three fibroids with a size of 5 cm. Compared with laparotomy, laparoscopic myomectomy has the advantages of small incisions, short hospital stay, less postoperative pain, rapid recovery and good assessment of other abdominal organs. Due to the concern of decreased ovarian reserve, uterine artery embolization is not advisable for these women. In addition, it is associated with high risks of miscarriages, preterm delivery and postpartum bleeding. Laparoscopic myolysis causes severe adhesion formation. Women with submucous fibroids receive myomectomy by hysteroscopy. For women who have completed their family, laparoscopic hysterectomy could be performed. Most fibroids can be managed endoscopically either by laparoscopy or hysteroscopy. Surgeon expertise, especially laparoscopic suturing, is crucial. Laparoscopic myomectomy is still the best treatment option for symptomatic women with uterine fibroids who wish to maintain their fertility. Hysteroscopic myomectomy is an established surgical procedure for women with excessive uterine bleeding, infertility or repeated miscarriages.
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ABSTRACT: The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.Obstetrics and Gynecology International 01/2012; 2012:194839. DOI:10.1155/2012/194839
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ABSTRACT: Uterine leiomyomas remain the commonest cause of menorrhagia and frequently cause pressure symptoms. Management of leiomyomas depends on the presenting symptoms, size, location, number of myomas, and the patient's desire to retain her uterus, fertility, or both. We present the first case of laparoscopic myomectomy for a fibroid measuring 30cm in maximum diameter.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2010; 14(1):120-2. DOI:10.4293/108680810X12674612015021 · 0.79 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the effectiveness of a fibrinogen and thrombin-coated hemostatic sponge (TachoSil®) in the prevention of postsurgical adhesions in a laparoscopic rat model and its histological effects on uterine and peritoneal parenchyma. Design was a prospective randomized blinded study. Setting was in International Laparoscopic Surgery Centre, Clermont-Ferrand, France. There were 100 sexually mature female Sprague–Dawley rats weighing 240 to 300g and aged 6–8weeks. A standardized severe surgical injury induced by scissors and 40-W bipolar coagulation in the rat uterine horn, corpus, and peritoneum was performed to induce adhesion formation. After trauma, group 1 (n = 50) received no treatment and group 2 rats (n = 50) received TachoSil® applied on injured areas. Twelve weeks after the procedure, repeat laparoscopy was performed and adhesions were scored according to their extent and severity. A hysterectomy and a peritoneal biopsy in the injured area were achieved by laparotomy in order to investigate on a possible earlier effect of TachoSil® on the uterine and peritoneal parenchyma in 49 rats of each group. TachoSil® group adhesion scores showed a significant decrease on the three injured areas: peritoneum (12.96 vs. 21.66), uterine horn (7.22 vs. 15.20), and uterine corpus (5.88 vs. 34.52). TachoSil® group also demonstrated a major decline of uterine fibrosis and inflammation. This study revealed that TachoSil®, an absorbable biomaterial, can reduce postoperative adhesions after laparoscopic surgery on a rat model. TachoSil® also prevents thermo-induced injuries on uterine parenchyma (less fibrosis and less inflammation).Gynecological Surgery 11/2009; 6(4):323-329. DOI:10.1007/s10397-009-0496-0