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Fibroids: Procedures
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Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
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The surgical removal of fibroids is called a myomectomy. Intramural and subserous fibroids up to 10 cm in diameter can be removed by laparoscopic myomectomy, through two small incisions 10 mm in length, one in the umbilicus (navel) and the other a little lower down in the midline of the abdomen. Two smaller incisions only 5mm in length are made, one on either side of the abdomen about three inches from the midline. Presently only a handful of surgeons in this country offer this procedure which takes much longer and is more challenging than conventional surgery. The picture below, on the left, is of an intramural fibroid of 5 cm in diameter prior to removal laparoscopically. The picture on the right shows the appearance after removal and laparoscopic repair.
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There are two general types of surgery available for fibroids, hysterectomy and myomectomy. Hysterectomy is the complete removal of the uterus with or without removal of the ovaries. In some cases hysterectomy can be performed through the vagina, avoiding an incision through the abdominal wall. However, with large fibroids, an abdominal hysterectomy (that is, a hysterectomy through an abdominal wall incision) is often necessary. Abdominal hysterectomy is a major surgical procedure requiring general anesthesia, approximately 6 days of hospitalization, and at least 6 weeks of recuperation. Obviously, pregnancy is no longer possible following a hysterectomy.
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New procedures that destroy rather than remove fibroids appear to shrink fibroids. In myolysis, a needle that transmits an electrical current is inserted into the fibroid during laparoscopy. The current is used to destroy the core of the fibroid, causing the fibroid to shrink. In cryomyolysis, a similar procedure, a cold probe (containing liquid nitrogen) is used to destroy the core of the fibroid. Whether these procedures affect the ability to become pregnant is unknown. Also, fibroids tend to grow back after these procedures.
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Embolization is a minimally invasive procedure for uterine fibroids during which an Interventional Radiologist injects microspheres through a tiny catheter to the site of the fibroid. The microspheres -- each about the size of a period at the end of this sentence -- block the blood flow to the fibroids causing them to atrophy. The procedure is an alternative for most women with fibroids to surgical procedures such as hysterectomy or myomectomy. Recovery time is measured in days rather than weeks.
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Resectoscope myomectomy is a technique that can be performed only if the fibroids causing the symptoms are within the uterine cavity. A small telescope, the resectoscope, is passed through the cervix, and the internal uterine cavity is seen. Electricity is passed through a thin wire attachment of the telescope allowing the instrument to cut through the fibroid like a hot knife through butter. This procedure is performed as outpatient surgery, without any incisions and most patients are able to go back to normal activity in one or two days.
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