Traditional Surgical Approaches to Uterine Fibroids: Abdominal Myomectomy and Hysterectomy

Abstract

Abdominal myomectomy and hysterectomy remain the traditional treatment of large symptomatic uterine myomas. The preoperative indications for abdominal myomectomy or hysterectomy must be clearly evaluated and delineated avoid unnecessary intervention. There appears to be an increasing trend toward expectant management for asymptomatic uterine myomas. Women should consider the options of myomectomy and hysterectomy when their symptoms are severe enough to warrant intervention and the benefits of intervention outweigh the risks. The advantages and disadvantages of preoperative medical also must be addressed before intervention. The factors influencing the choice of therapy seem to be strongly dependent on both the patient and physician preferences. A clinical approach to abdominal myomectomy in patients with infertility and repetitive miscarriage has been presented in this chapter. The rapid development and use of minimally invasive innovations and adjunctive medical therapies has provided clinicians with a wealth of alternatives. A practical and cost-effective approach based on the data currently available have been presented; however, there remains a paucity of prospective randomized data to evaluate and compare the effectiveness and safety of these alternative treatments to abdominal myomectomy and hysterectomy. Future studies should help define the optimal candidates for traditional surgical treatment with abdominal myomectomy and hysterectomy.

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

“…An ideal conservative treatment for uterine myomas should be safe, eliminate symptoms, decrease the size of myomas, preserve fertility and have long-term effects. Several procedures including endometrial ablation, uterine artery embolization, high-intensity focused ultrasound and myolysis have been suggested or developed as a conservative treatment to avoid hysterectomy or myomectomy (Guarnaccia & Rein, 2001;Myers et al, 2002).…”

“…Hysteroscopic myomectomy is an method for the management of abnormal uterine bleeding caused by submucous leiomyomas. Submucosal leiomyomas are estimated to be the cause of 5-10% of cases of abnormal uterine bleeding, pain, and subfertility and infertility (Guarnaccia & Rein, 2001;Narayan et al, 2010;Wallach & Vlahos, 2004). Laparoscopic myomectomy minimizes the size of the abdominal incision, resulting in a quicker postoperative recovery, a shorter time to hospital discharge, reduced analgesic requirements and less blood loss.…”

Conservative treatment of fibroids

“…However, hysterectomy continues to be financially costly with billions of dollars spent annually, as well as costly in more fundamental terms of morbidity and mortality when compared with the less invasive alternatives of myomectomy, ablation, and myolysis [11][12][13]. Myomectomy involves the shelling out of fibroids from the myometrium, and in the case of submucosal fibroids, these can be removed surgically via hysteroscopic procedures [14].…”

Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study

“…The traditional treatments for symptomatic fibroids are represented by major surgery, such as hysterectomy and myomectomy, both of which are associated with significant complications and considerable morbidity [7]. Moreover, hysterectomy don't preserve the uterus and fertility, so, in woman who want future pregnancies or who wish to retain their uterus for other reasons, the traditional surgical treatment is myomectomy, which may be performed via laparotomy, laparoscopy, hysteroscopy or transvaginal, but it isn't a definitive therapy in many cases.…”