Uterine Fibroids and Hysterectomy - Other Procedures

Highlights	Complications	Other Procedures
Introduction	Diagnosis	Hysterectomy
Causes	Lifestyle Changes	Resources
Symptoms	Medications	References
Risk Factors	Surgery

Other Procedures

In order to operate on the uterus, the surgeon may choose to reach the area through a wide abdominal incision (laparotomy) or using less invasive measures with the use of endoscopy. The decision usually is based on the severity of the case. It should be noted that research on treatments for uterine fibroids is very scanty and even physicians may not have the best data needed to make an optimal decision for their patient. Women should discuss all options very carefully and be sure that their surgeons have had experience with any procedure they choose.

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Laparotomy. Laparotomy is the standard abdominal surgical procedure. It is invasive and usually requires a wide abdominal horizontal incision right above the pubic bone, the so-called bikini incision.

Endoscopy. Endoscopic techniques used for uterine disorders are hysteroscopy and laparoscopy. Endoscopic techniques are used increasingly to replace conventional surgical techniques for many disorders. A common factor in all endoscopic procedures is the use of a fiberoptic scope and tubes, tiny camera lenses, and minuscule surgical instruments. Any incisions used are very small, Band-Aid size.

Operative Hysteroscopy. In this procedure, the cervix is dilated, which requires either a local or general anesthetic. A device called a hysteroscopy is inserted up through the vagina and cervix into the uterine cavity. It contains tiny surgical instruments as well as a mini-camera and light source to view images of the uterus, which are transmitted to a video monitor. This approach is becoming increasingly common. Complication rates include excessive fluid absorption, infection, and uterine perforation.
Laparoscopy. This procedure employs two or more small incisions, one at the navel, and one or more in the lower abdomen. Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away. A laparoscope is inserted through the navel incision and a probe is inserted through a second incision above the pubic hairline. The probe allows the physician to directly view the abdominal cavity, including the outer walls of the uterus, fallopian tubes, and ovaries. The physician manipulates surgical instruments that are passed through additional small abdominal incisions, using the image of the uterus on the video monitor as the guide.

Preoperative Hormone Treatment

GnRH agonists, usually depo-Lupron or Synarel, are often used for about two to three months before many uterine surgical procedures.

There are a number of benefits:

May reduce the volume of fibroids by 40% to 60%, in some cases to the extent that a less invasive procedure may be performed.
May reduce the risk of bleeding.
May shorten operating time.
May reduce postoperative symptoms for many patients.

Treatments may not be useful, however, for small fibroids, which may shrink to the point that they are no longer visible at the time of surgery. Since fibroids regrow after treatment, the problem would recur.

There has also been some question whether these drugs provide any additional advantages for myomectomies that use conventional surgical techniques. Ultrasound may be useful in helping to detect fibroids most likely to benefit from GnRH agonists before such a procedure.