Minimally Invasive Solutions For Fibroids

By Paul MacKoul, MD, FACOG

Uterine fibroids can make a womans life pretty miserable. Pain, severe cramps and heavy menstrual flow are common. Less common symptoms include interference with urinary and bowel function, including frequent urination or constipation, due to enlargement of the fibroids and uterus.
For years women have endured such discomfort because conventional surgical treatment of uterine fibroids means open surgery that requires days in the hospital and weeks of painful recovery with many restrictions. Rather than go through such a drastic procedure, many women opt to endure the pain during their monthly cycles and ultimately delay treatment until the symptoms are unbearable because they cant take weeks off work or dont have childcare while they recuperate.
One alternative treatment that is available to some women is uterine artery embolization (UAE). This technique blocks blood flow to the uterus, causing fibroids to shrink as the tissue dies. UAE can be very successful, depending on the physician performing the procedure and the type of fibroids. Unfortunately, patients with very large or rapidly growing fibroids are often not good candidates for the procedure. Patients who may wish to have children in the future should also not undergo UAE. Common side effects include pelvic pain, nausea, vomiting, and fever. More severe complications may include uterine rupture, systemic infection and sepsis, and ovarian failure.
Rather than have open surgery or potentially risky UAE, one option for Washington-area women is minimally invasive surgery. Advanced laparoscopic techniques can be used for fibroids of any size by a properly trained gynecologic laparoscopic surgeon. Using tiny, -inch incisions, advanced laparoscopic surgeons can remove fibroids weighing up to several pounds. The success rates for fibroid removal (myomectomy) and hysterectomy are over 95%.
If you are interested in seeking minimally invasive treatment for your fibroids (or for any other gynecologic condition), you need to understand that choosing the most experienced surgeon will determine the likelihood of receiving a minimally invasive treatment. Many doctors who have not received specialized education in laparoscopic techniques will tell patients that laparoscopic surgery isnt an option for them, but it is the surgeon, not the patients condition, that often determines whether to use a minimally invasive approach.
Since surgical skill comes from experience, when choosing a surgeon, you should always ask whether the doctor has completed a fellowship in laparoscopic surgery, how many procedures like yours he or she does each month, and what are his or her complication rates.