Overview of current surgical management of fibroids: ‘Organ-preserving modalities’

Summary

Uterine fibroids are the most common solid tumours occurring in female pelvis and frequently encountered by gynaecologists. Generally about 50% remain asymptomatic and can be monitored through regular follow-up visits but symptomatic fibroids require surgical intervention at some stage. They occur in 25 – 50% of women over the age of 30 years, increasing with age and being more common in certain ethnic populations, especially the Afro-Caribbean. They have a major impact on women's health and were the most common indication for hysterectomy in England in 1993 – 1994.They have significant cost implications, the 72,362 hysterectomies performed in 1993 – 1994 costing the NHS an estimated £70 million. Although hysterectomy is the most certain cure for women with symptomatic fibroids who do not wish to preserve fertility, an increasing number of women are choosing and looking for the options of organ-conserving surgery. The surgery can be carried out abdominally, laparoscopically and vaginally although all routes are associated with an appreciable rate of morbidity. The discussion of organ-preserving surgery includes mainly myomectomy, transcervical resection of fibroid, uterine artery embolisation (UAE) and MRI-guided laser ablation. Hysterectomy is associated with a high rate of satisfaction and is likely to relieve menstrual problems in almost all women. Much work has been undertaken on this subject so far, with a view to safe and effective surgical approaches.

Keywords:

• Minimal access surgery
• myoma
• UAE
• uterine leiomyoma