Skip to main content

Minimally Invasive Approaches to Treat Symptomatic Uterine Myomas

  • Chapter
  • First Online:
  • 560 Accesses

Abstract

Uterine myomas are common in reproductive-aged women. Traditionally, treatment for symptomatic myomas in women wishing to preserve their ability to have children has been abdominal myomectomy. While this procedure is very successful in improving symptoms related to the myomas, it is associated with surgical morbidity, patient hospitalization, and a prolonged postoperative recovery. Newer, less invasive techniques are now available to treat symptomatic uterine myomas including laparoscopic and robotically assisted laparoscopic myomectomy, ­uterine artery embolizaiton, and MRI-guided ultrasound ­focused surgery. These techniques have the advantage of less morbidity and quick recovery. Many studies have shown promising results with regard to improvement in myoma-related symptoms. However, concerns have been raised about using these procedures for women who would like to become pregnant. Further studies are needed to evaluate the risks and benefits compared to standard treatment options.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Buttram VC, Reiter RC. Uterine leiomyomate: etiology, symptomatology, and management. Fertil Steril 1981;36:433–5.

    PubMed  Google Scholar 

  2. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188:100–7.

    Article  PubMed  Google Scholar 

  3. Goodwin SC, Bradley LD, Lipman JC, et al. Uterine artery embolization versus myomectomy: a multiceter comparative study. Fertil Steril 2006;85:14–21.

    Article  PubMed  Google Scholar 

  4. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 2000;183:1448–55.

    Article  PubMed  CAS  Google Scholar 

  5. Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB. Recurrence of leiomyomata after myomectomy. Hum Reprod Update 2000;6:595–602.

    Article  PubMed  CAS  Google Scholar 

  6. Candiani GB, Fedele L, Parazzini F, Villa L. Risk of recurrence after myomectomy. Br J Obstet Gynecol 1991;98: 385–9.

    Article  CAS  Google Scholar 

  7. Malone LJ. Moymectomy: recurrence after removal of solitary and multiple myomas. Obstet gynecol 1969;43:200–3.

    Google Scholar 

  8. Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertil Steril 2006;86:S194–9.

    Google Scholar 

  9. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril 2005;83:1–23.

    Article  PubMed  Google Scholar 

  10. Mais V, Ajossa S, Gueriero S, et al. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996;174:654–8.

    Article  PubMed  CAS  Google Scholar 

  11. Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 2000;15:2663–8.

    Article  PubMed  CAS  Google Scholar 

  12. Dubuisson JB, Fauconnier A, Babaki-Fard K, Chapron C. Laparoscopic myomectomy: a current view. Hum Reprod Update 2000;6:588–94.

    Article  Google Scholar 

  13. Sinha K, Hedge A, Warty N, Patil N. Laparoscopic excision of very large myomas. J Am Assoc Gynecol Laparosc 2003; 10:461–8.

    Article  PubMed  Google Scholar 

  14. Seracchioli R, Colombo FM, Bagnoli A, et al. Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure? Br J Obstet Gynaecol 2003;110:236–40.

    Article  CAS  Google Scholar 

  15. Torng P, Hwang J, Huang S, et al. Effect of simultaneous morcellation in situ on operative time during laparoscopic myomectomy. Hum Reprod 2008;23(10):2220–6.

    Article  PubMed  Google Scholar 

  16. Paul PG, Koshy AK. Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation. Fertil Steril 2006;85:492–3.

    Article  PubMed  CAS  Google Scholar 

  17. Kumar S, Sharma JB, Verma D, et al.. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Arch Gynecol Obstet 2008;278:93–5.

    Article  PubMed  Google Scholar 

  18. Moon HS, Koo JS, Park SH, et al. Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril 2008;90(4):1201.e1–2.

    Article  Google Scholar 

  19. Rossetti A, Sizzi O, Soranna L, et al. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 2001;16: 770–4.

    Article  PubMed  CAS  Google Scholar 

  20. Rossetti A, Sizzi O, Chiarotti F, Florio G. Developments in techniques for laparoscopic myomectomy. J Soc Laparo­endos Surg 2007;11:34–40.

    Google Scholar 

  21. Dubuisson JB, Fauconnier A, Deffarges JV, et al.. Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 2000;15:869–73.

    Article  PubMed  CAS  Google Scholar 

  22. Landi S, Zaccoletti R, Ferrari L, Minelli L. Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc 2001;8: 231–40.

    Article  PubMed  CAS  Google Scholar 

  23. Yoo EH, Lee PI, Huh CY, et al.. Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invas Gynecol 2007;14:690–7.

    Article  Google Scholar 

  24. Fedele L, Parazzuni F, Luchini L, et al. Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study. Hum Reprod 1995;10:1795–6.

    PubMed  CAS  Google Scholar 

  25. Hanafi M. Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 2005;105:877–81.

    Article  PubMed  Google Scholar 

  26. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993;82:213–5.

    PubMed  CAS  Google Scholar 

  27. The Myomectomy Adhesion Multicenter Study Group. An expanded polytetrafluotoethylene barrier (Gore-tex Surgical Membrane) reduces post-myomectomy adhesion formation. Fertil Steril 1995;63:491–3.

    Google Scholar 

  28. Ugur M, Turan C, Mungan T, et al. Laparoscopy for adhesion prevention folloiwng myomectomy. Int J Gynecol Obstet 1996;53:145–9.

    Article  CAS  Google Scholar 

  29. Takeuchi H, Kitade M, Kikuchi I, et al. Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy. Fertil Steril 2008;89: 1247–53.

    Article  PubMed  Google Scholar 

  30. Dubuisson JB, Fauconnier A, Chapron C, Kreiker G, Norgaard C. Second look after laparoscopic myomectomy. Hum Reprod 1998;13:2102–6.

    Article  PubMed  CAS  Google Scholar 

  31. Takeuchi H, Kitade M, Kikuchi I, et al. Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy. Fertil Steril 2008;89:1247–53.

    Article  PubMed  Google Scholar 

  32. Mais V, Ajossa S, Piras B, et al. Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Hum Reprod 1995;10:3133–5.

    PubMed  CAS  Google Scholar 

  33. Pellicano M, Bramante S, Cirillo D, et al. Effectiveness of autocrosslinked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study. Fertil Steril 2003;80:441–4.

    Article  PubMed  Google Scholar 

  34. Mais V, Bracco GL, Litta P, Gargiulo T, Melis GB. Reduction of postoperative adhesions with an auto-crosslinked hyalu­ronan gel in gynaecological laparoscopic surgery: a blinded, controlled, randomized, multicentre study. Hum Reprod 2006;21:1248–54.

    Article  PubMed  CAS  Google Scholar 

  35. Palomba S, Zupi E, Falbo A, et al. A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes. Fertil Steril 2007;88:933–41.

    Article  PubMed  Google Scholar 

  36. Seinera P, Farina C, Todros T. Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients. Hum Reprod 2000;15:1993–6.

    Article  PubMed  CAS  Google Scholar 

  37. Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 2007;19:331–6.

    Article  PubMed  Google Scholar 

  38. Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 2004;11:511–18.

    Article  PubMed  Google Scholar 

  39. Advincula AP, Xu X, Goudeau S, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invas Gynecol 2007;14:698–705.

    Article  Google Scholar 

  40. Nezhat C, Lavie O, Hsu S, et al. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy- a retrospective matched control study. Fertil Steril 2008 March 28 [Epub ahead of print]

    Google Scholar 

  41. Ravina JH, Ciraru-Vigneron N, Bouret JM, et al. Arterial embolisation to treat uterine myomata. Lancet 1995;346:671–2.

    Article  PubMed  CAS  Google Scholar 

  42. Parker WH. Uterine myomas: management. Fertil Steril 2007;88:255–71.

    Article  PubMed  Google Scholar 

  43. Pron G, Bennett J, Common A, et al. The Ontario uterine fibroid embolization trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 2003;79:120–7.

    Article  PubMed  Google Scholar 

  44. Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. Br J Obstet Gynaecol 2002;109:1262–72.

    Article  CAS  Google Scholar 

  45. Broder MS, Goodwin S, Chen Get al. comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet gynecol 2002;100:864–8.

    Article  PubMed  Google Scholar 

  46. Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2006;126:226–33.

    Article  PubMed  Google Scholar 

  47. Mara M, Maskova J, Fucikova Z, et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Interv Radiol 2008;31:73–85.

    Article  Google Scholar 

  48. Spies JB, Bruno J, Czeyda-Pommersheim F, et al. Long-term outcome of uterine artery embolization for leiomyomata. Obstet Gynecol 2005;106:933–9.

    Article  PubMed  Google Scholar 

  49. WalkerWJ, McDowell SJ. Pregnancy after uterine artery embolization for lieomyomata: a series of 56 completed pregnancies. Am J Obstet Gynecol 2006;195:1266–71.

    Article  PubMed  Google Scholar 

  50. Goldberg J, Pereira L, Berghella V, et al. Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol 2004;191:18–21.

    Article  PubMed  Google Scholar 

  51. Hindley J, Gedrovc WM, Regan L, et al. MRI guidance of focused ultrasound therapy of uterine fibroids; early results. Am J Roentgenol 2004;183:1713–9.

    Google Scholar 

  52. 52.Stewart EA, Rabinovici J, Tempany CM, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 2006;85:22–9.

    Article  PubMed  Google Scholar 

  53. Stewart E, Gostout M, Rabinovici J, et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007;110:279–87.

    Article  PubMed  Google Scholar 

  54. Morita Y, Ito N, Ohashi H. Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynecol and Obstet 2007;99:56–68.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. M. Pfeifer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Pfeifer, S.M., Pfeifer, S. (2009). Minimally Invasive Approaches to Treat Symptomatic Uterine Myomas. In: Voorhis, B., Schlegel, P., Racowsky, C., Carrell, D. (eds) Biennial Review of Infertility. Humana Press. https://doi.org/10.1007/978-1-60327-392-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-392-3_3

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-391-6

  • Online ISBN: 978-1-60327-392-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics