Minimal access treatments for fibroids

Fibroids are common benign tumours of the uterus and are very prevalent in African-Caribbean women.

They can be symptomatic or asymptomatic, if symptomatic they usually present with heavy menses, painful menses, urinary frequency due to pressure symptoms or as a palpable mass felt in the abdomen.

Fibroids can be pedunculated (on a stalk), serosal (on the surface), myometrial (in the muscle), submucosal (in the uterine cavity) and cervical.

Fibroids when symptomatic present mainly with heavy menstrual bleeding and/or painful menses.
The main causes would be submucosal and myometrial fibroids, this is because they increase the surface area of the endometrium.

There are different types of treatment based on where the fibroids are.

These include

n Hysteroscopic.
n Laparoscopic
n Uterine Artery embolization

Hysteroscopic treatment is where a camera is placed in the womb via the vagina and the individual fibroids are removed under direct vision. This technique is usually for fibroids which are found on the inside of the womb and preserves the womb and is called trans-cervical resection of a fibroid.

This is done as a day-case or in the office as an outpatient and is associated with a quicker recovery and return to normal activities and blood loss is minimal.

This technique reduces the heavy bleeding or intermenstrual bleeding if present.

After the resection at the same time if the patient has completed her family the endometrial cavity can be ablated.

Endometrial ablation is a technique where the lining of the womb is destroyed by thermal means via a balloon or by radiofrequency and can be done as an outpatient or inpatient.

The advantages include:
High amenorrhea rates
Less pain
Quicker recovery
Faster return to normality
Minimal complications if any when compared to hysterectomy
Higher satisfaction rate

Laparoscopic treatment includes laparoscopic myomectomy or laparoscopic hysterectomy. These are surgical techniques where the individual fibroids are removed via keyhole surgery via 3 or 4 small incisions.

Advantages include
Less pain
Quicker recovery
Faster return to normality
Less blood loss
When compared to open surgery the benefits are numerous and associated with high satisfaction rates.

Uterine artery embolization is a technique where the blood supply of the fibroid is blocked off and this is done via a groin incision thus avoiding major surgery, one is able to shrink fibroids more than 50% in some cases.
This technique involves an overnight stay.

In summary there are many minimal access treatments for fibroids, these should be discussed thoroughly with patients to let them know their options to make an informed decision on the best mode of treatment.

Dr John Barker Bsc MBBS MRCOG, Dip (Risk Management) is an Obstetrician/Gynaecologist at Arnos Vale Medical Center, He has a specialist interest both Laparoscopic and Hysteroscopic Surgery.