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Hysteroskopische Resektion und Radiofrequenzablation uteriner Myome

Hysteroscopic resection and radiofrequency ablation of uterine fibroids

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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Myome des Uterus zählen zu den häufigsten benignen Erkrankungen der Frau. Die Inzidenz beträgt 25–30 %, und mehr als 60 % der Frauen im Alter bis 50 Jahre entwickeln im Laufe ihres Lebens uterine Myome. Minimal-invasive Therapieoptionen und Uteruserhalt gewinnen nach wie vor an Bedeutung. Die operativ-hysteroskopische Resektion uteriner Myome hat sich seit mehr als 20 Jahren etabliert, als moderne Option ergänzt die transzervikale Radiofrequenzablation (RF-Ablation) das Spektrum der operativen Myombehandlung.

Fragestellung

Die operativ-hysteroskopische Resektion und die RF-Ablation von Myomen werden als Operationstechniken mit transzervikalem Zugang auf Grundlage eigener Ergebnisse und aktueller Studiendaten einander gegenübergestellt.

Material und Methoden

Die operativ-hysteroskopische Myomresektion ist als etablierte Operationstechnik submuköser Uterusmyome in unserer Abteilung mit ca. 70 Eingriffen jährlich eine Standardtherapie. Die seit 2011 von uns praktizierte transzervikale ultraschallgesteuerte RF-Ablation submuköser und intramuraler Myome findet im Rahmen unseres Kompetenzzentrums mit inzwischen 77 Eingriffen zunehmend Anwendung.

Ergebnisse

Die Operationsdauer kann bei der RF-Ablation im Vergleich mit der hysteroskopischen Resektion von Myomen vergleichbarer Größe deutlich gesenkt werden. Weiterhin lassen sich perioperative Risiken durch das kontinuierliche intrauterine Ultraschallmonitoring der RF-Ablation reduzieren.

Diskussion

Die klassische hysteroskopische Resektion von Myomen ist nach wie vor der Standard der minimal-invasiven transzervikalen operativen Behandlung submuköser Myome. Die RF-Ablation bietet jedoch Vorteile hinsichtlich einer Reduzierung von Operationsdauer und perioperativen Risiken sowie hinsichtlich des Spektrums therapierbarer Myome.

Abstract

Background

Uterine fibroids are one of the most frequent benign disorders in women. The incidence is 25–30% and more than 60% of women up to 50 years of age develop uterine fibroids during the course of life. Fibroids can cause abnormal uterine bleeding, dyspareunia, bulk symptoms and implantation failure. Minimally invasive treatment and uterus preservation are gaining in importance. Hysteroscopic resection of uterine fibroids has been established as a standard therapy for more than 20 years. Transcervical radiofrequency ablation is a modern option which increases the spectrum of surgical treatment for uterine fibroids.

Objectives

Hysteroscopic resection and radiofrequency ablation of uterine fibroids as transcervical techniques are compared based on own results and current study data.

Materials and methods

Hysteroscopic resection of uterine fibroids is a standard technique for the treatment of submucosal uterine fibroids in this department with approximately 70 procedures per year. Intrauterine ultrasound-guided transcervical radiofrequency ablation has been performed to treat submucosal and intramural fibroids in this competence center since 2011 and is increasingly being implemented with 77 cases to date.

Results

The duration of the operative procedure for radiofrequency ablation compared with hysteroscopic resection of uterine fibroids with a similar size can be significantly reduced. Furthermore, the perioperative risks are reduced by continuous intrauterine ultrasound monitoring.

Conclusions

The classical hysteroscopic resection of uterine fibroids is still the standard for minimally invasive transcervical operative treatment of submucosal uterine fibroids; however, radiofrequency ablation offers advantages with respect to a reduced duration of surgery, fewer perioperative risks and a larger spectrum of uterine fibroids that can be treated.

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Authors and Affiliations

  1. Abteilung für Gynäkologie und Geburtshilfe, Evangelisches Klinikum Köln-Weyertal, Weyertal 76, 50931, Köln, Deutschland

    R. Bends & T. Römer

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  1. R. Bends
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Correspondence to R. Bends.

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Interessenkonflikt

R. Bends erhielt Beraterhonorar und Erstattung von Hotel- und Reisekosten von der Firma Gynesonics. T. Römer erhielt Beraterhonorare und Erstattung von Reisekosten von den Firmen Gynesonics, Gedeon-Richter, Bayer, Dr. Kade und Exeltis.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

R. Felberbaum, Kempten

W. Küpker, Bühl

T. Strowitzki, Heidelberg

M. Kiechle, München

Caption Electronic Supplementary Material

Zusätzliches Video 1: Lokalisation, Ablation und Regression des Myoms. (Mit freundl. Genehmigung ©[Gynesonics], alle Rechte vorbehalten) https://doi.org/10.1007/s00129-019-4416-8

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Bends, R., Römer, T. Hysteroskopische Resektion und Radiofrequenzablation uteriner Myome. Gynäkologe 52, 273–279 (2019). https://doi.org/10.1007/s00129-019-4416-8

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  • DOI: https://doi.org/10.1007/s00129-019-4416-8

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