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Paul MacKoul, MD, FACOG
Minimally Invasive Treatment of Fibroids
The Center for Innovative GYN Care
. http://innovativegyn.com/

Minimally Invasive Treatment of Fibroids

Uterine fibroids can make a womans life pretty miserable. Pain, severe cramps and heavier menstrual flow, which may result in anemia, are common. Less common symptoms include compression and partial obstruction of the bladder and bowel due to massive enlargement of the fibroids and uterus, which causes both the frequent need to urinate and constipation.
For years women have endured such discomfort because conventional surgical treatment of uterine fibroids is significant an open procedure into the abdominal cavity with removal of fibroids or the uterus to control symptoms associated with this condition. Rather than go through such a drastic procedure and have to endure lengthy recovery periods, woman opted to endure the pain during their monthly cycles.
Uterine artery embolization (UAE) is now being used more frequently for treatment of fibroids. This technique obstructs the uterine artery bilaterally, thereby decreasing blood flow to the uterus and the fibroids, resulting in shrinkage of the fibroids through necrosis. UAE has a success rate of up to 85%, depending on the interventional radiologist performing the procedure and patient selection. Patients with pedunculated fibroids (on a stalk) or those with very large or rapidly growing fibroids are often not good candidates for the procedure. Patients interested in preserving fertility should also not undergo UAE. Common side effects of uterine artery embolization include pelvic pain due to necrosis of the fibroids, nausea, vomiting, elevated temperatures, passage of submucous myomas, and elevated white cell counts. More severe complications such as uterine rupture, sepsis, ovarian failure due to obstruction of the collateral vessels to the ovary, and death have been reported.
Advanced laparoscopic techniques have overcome these limitations and can be used for removal of uterine fibroids of almost any size. Fibroids as large as 3,000 grams have been removed with these techniques with incision sizes no larger than to inch. The success rates for both fibroid removal and hysterectomy are impressive at over 95%.
Advanced laparoscopic surgery uses retroperitoneal dissectionan intricate procedure only a few surgeons are trained to perform. Blood loss with this technique is usually minimal, and complications are exceptionally low.
The entire fibroid or uterus can be removed safely and easily through a few small incisions. Pain after the procedure is usually limited and minimal which means women are up and about and can tolerate a regular diet the day after surgery. Return to normal daily activities occurs in a very short period of time, ranging from three to ten days.
Advanced laparoscopic hysterectomy and myomectomy (removal of fibroids only) have revolutionized the way in which fibroids are treated. The wide application of these procedures to almost all women coupled with the low complication rate, minimal hospitalization and pain, and fast recovery make them an effective and safe form of treatment for women with a variety of uterine problems.

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