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  • Women's Health: Uterine Fibroids Surgical Treatment Options

  • Women's Health: Uterine Fibroids
    Surgical Treatment Options

    Surgical options include hysterectomy, myomectomy and myolysis.

    Hysterectomy involves complete removal of the uterus. Approximately 400,000 hysterectomies are performed in the USA each year for fibroids. Obviously, this treatment is only for women who no longer wish to have children. A hysterectomy is traditionally performed through an open abdominal incision. Some women may be candidates for laparoscopic hysterectomy. Both types of hysterectomy are surgical procedures and usually require general anesthesia and a 3-4 day hospital stay. Depending upon the approach used, the recuperation period averages 4-12 weeks. Because the uterus is removed there is no future risk of cancer developing.

    Myomectomy involves removal of the fibroids with preservation of the uterus. Left in place, the uterus is generally capable of sustaining pregnancy. This treatment is generally used for patients with small fibroids (less than 5 cm in diameter) and less than 5 in total number. It may be performed by one of three approaches depending upon the location of the fibroid. Unfortunately, fibroids can recur after myomectomy. Approximately 10% of patients will require repeat myomectomy or hysterectomy for adequate control of recurrent fibroids.

    • Hysteroscopic myomectomy is used for fibroids just beneath the inner lining of the uterus (submucosal) that may protrude into the uterine cavity (intracavitary). The flexible scope (hysteroscope) is inserted through the vagina and cervix into the uterine cavity. The fibroid or fibroids are then removed using special tools. This technique is usually performed while the patient is under general anesthesia, but requires a much shorter stay and recovery period than hysterectomy.

    • Laparoscopic myomectomy is used primarily for fibroids in the mid to outer layer of the uterus (intramural and subserosal). Small skin incisions in the lower abdomen allow the doctor to place the scope (laparoscope) and operating instruments into the space adjacent to the uterus. This to allow visualization and removal of the fibroids. General anesthesia is required as well as a 3-6 week recovery period.

    • Abdominal myomectomy is an open surgical procedure in which an incision is made in the lower abdomen to allow visualization of the uterus. A subsequent incision is made in the uterus to allow removal of the fibroid or fibroids. This procedure usually requires general anesthesia, a 2-3 day hospital stay, and a 4-6 week recovery period

    Myolysis is a newer technique by which the fibroid is destroyed by placing a probe within it and applying and electrical current or laser to the tissue. This probe is usually placed through a small skin incision in the abdomen similar to that used for laparoscopy. Myolysis is less invasive than hysterectomy and allows preservation of the uterus. Unfortunately, the technique has not been used widely and currently only a few centers have a large experience with the technique. Furthermore, there has been a relatively high rate of post-procedure complications. Finally, it remains unclear whether the uterus can sustain pregnancy post-myolysis. More data on myolysis should be available in the next few years, which may clarify its role in treating fibroids.

     

    Information in this section is provided by Rhode Island Hospital's department of radiology, which offers a complete range of diagnostic and interventional procedures for women, including uterine artery embolization, a leading treatment for fibroid tumors.

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