MINOR / MAJOR SURGICAL SOLUTIONS FOR UTERINE FIBROIDS

We have described, in preceding columns, how uterine fibroids can cause heavy menstrual bleeding, as well as significant pain, pelvic pressure, and pain during sexual intercourse. Fibroids are often responsible for infertility.

Pelvic ultrasonography is the most effective mode of diagnosis.

Now, we will consider surgical treatment options for patients who do not wish to retain their fertility. They may have completed their families, or have passed into menopause, or have opted to forego childbearing.

This discussion progresses from the minor, outpatient options, to the major surgical solutions for symptomatic fibroids.

Firstly, the Acessa procedure is an option. It entails laparoscopic destruction of uterine fibroids by means of a radio-­‐frequency needle, and is the least invasive of options. It does not impact fertility, and is appropriate for patients of all age groups, and of all reproductive intentions.

Next, the endometrial ablation may be available to a subset of fibroid patients, depending on the fibroid location. This outpatient surgery involves localized destruction of the uterine lining only, and may decrease bleeding, but does not impact the fibroid directly, nor the other symptoms, of pain or pressure. It is performed through the cervix.

Myomectomy is the removal of one or more fibroids, and may be performed laparoscopically, robotically-assisted, or through an incision.

The definitive surgery has long been the removal of the uterus: hysterectomy. This may be affected vaginally, or through an abdominal incision, or with the laparoscope and/or robot. It does not require removal of ovaries.

There are pros/cons, as well as limitation to all of the above procedures. Your Gynecologic surgeon can provide you with information to make an appropriate decision, individualized.

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