Endoscopic management of uterine fibroids
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.
Available from: Grigoris F Grimbizis
- "However, they stated that these figures should be interpreted with caution, due to the very low number of available and included studies . Regarding the surgical approach, the two available RCTs asserted that there was no difference in fertility restoration, but the use of laparoscopy appeared to be more advantageous for postoperative recovery and morbidity [21,22]. Based on the available evidence from all types of studies, it seems that (1) previous myomectomy does not negatively affect pregnancy rates, thus supporting the notion that surgery per se is not detrimental; (2) hysteroscopic excision of submucosal myomas seems to restore the fertility potential of patients and pregnancy rates after surgery are similar to normal controls; (3) removal of intramural myomas of size >5 cm seems to be associated with higher pregnancy rates compared to non-operated controls, although evidence is not still sufficient; and (4) both abdominal and laparoscopic approach are equally effective in fertility restoration, but laparoscopy is associated with better postoperative course and less morbidity. "
[Show abstract] [Hide abstract]
ABSTRACT: Uterine fibroids are the most common tumours in women and their prevalence is higher in patients with infertility. At present, they are classified according to their anatomical location, since there is no classification system to include additional parameters, like their size or number.
Available from: David Toub
- "While often asymptomatic, fibroids can result in abnormal uterine bleeding, pelvic pressure, pain, subfertility, dyspareunia, and other symptoms. Submucous and intramural fibroids are most associated with heavy menstrual bleeding (HMB)    ; subserosal fibroids are more often innocuous unless sufficiently large so as to contribute to bulk symptoms. Many fibroids contain elements of more than one fibroid type; that is, fibroids may have submucous and subserosal components and may be transmural. "
[Show abstract] [Hide abstract]
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.
- "A consensus gradually emerges that the maximal size must be 8-10 cm and the total number of fibroids should not exceed four. Some authors’ criteria for laparoscopic myomectomy are a single intramural or subserosal fibroid ≤15 cm or three or fewer fibroids of ≤5 cm, whereas, others believe in an individual choice based on pathological findings and surgical skill. It is prudent not to perform laparoscopic myomectomies with more than five to seven large myomas because in these cases, the procedure is excessively time-consuming and the surgeon can miss the smaller myomas after the uterus has been incised and repaired in too many places. "
[Show abstract] [Hide abstract]
ABSTRACT: To review the literature and summarize the available evidence about the relationship of fibroids with infertility and to review the role of laparoscopic myomectomy in infertility.
Medline, PubMed, and Cochrane Databases were searched for articles published between 1980 and 2010.
Fertility outcomes are decreased in women with submucosal fibroids, and myomectomy is of value. Subserosal fibroids do not affect fertility outcomes, and removal may not confer benefit. Intramural fibroids appear to decrease fertility, but the results of therapy are unclear. Although pregnancy rates for women with leiomyomata, managed endoscopically, are similar to those after laparotomy, there is a risk of uterine rupture. The risk is essentially unknown. Finally, the risk of recurrence seems higher after laparoscopic myomectomy compared to laparotomy.
Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique, with an extremely low failure rate and good results in terms of the outcome of pregnancy.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.