Hysteroscopic laser ablation of symptomatic uterine fibroids: insights from a prospective study

Abstract

Objective

This study aimed to evaluate the feasibility and efficacy of in-office hysteroscopic ablation of submucous uterine fibroids using a diode laser.

Method

A pilot study was conducted between January 2018 and January 2019 in a tertiary care university hospital. Patients with at least one symptomatic, class 0–2 FIGO classification, uterine fibroid ≤7 cm in size were eligible for inclusion. Evaluation of the changes in fibroid size and vascularity was performed using three-dimensional Doppler ultrasonography. Vaporization of the fibroid core was conducted using a 980–1470 nm wavelength diode laser inserted through the hysteroscope’s working channel. The primary outcome was evaluation of the fibroid volume before and at 2 months after the procedure.

Results

Twenty women were enrolled in the study. At 2-month follow-up, the volume of the fibroids was significantly reduced (51.6 ± 22.5 vs. 33.4 ± 17.1 mm³; p < 0.001). A major reduction of three-dimensional sonographic color Doppler vascularity (observed by the same operator and confirmed by four blind reviewers) was also achieved in 12/20 patients (60%; p = 0.03) while a reported symptom of heavy menstrual bleeding decreased from 18/20 (90%) to 2/18 (10%; p < 0.01).

Conclusion

Hysteroscopic laser ablation represents a feasible and effective alternative for treating women with symptomatic submucous fibroids in the office setting. Further studies with larger sample size and longer follow-up periods are needed to validate this promising technique.

Key message

• This pilot study shows that in-office hysteroscopic laser ablation (HLA) could be a feasible alternative to treat symptomatic submucous uterine fibroids by coagulating their core, reducing their size and vascularization.

摘要

目的: 本研究旨在评估门诊宫腔镜使用半导体激光消融粘膜下子宫肌瘤的可行性和有效性。

方法: 2018年1月至2019年1月期间, 在一家三级甲等大学医院开展了一项试点研究。至少有一种症状、FIGO分级0-2级、子宫肌瘤大小≤7厘米的患者符合纳入条件。使用三维多普勒超声波检查评估肌瘤大小和血管分布的变化。使用波长为 980-1470nm 的半导体激光通过宫腔镜的工作通道对肌瘤核心进行汽化。主要结果是评估手术前和手术后两个月的肌瘤体积。

结果: 20名女性参与了这项研究。在2个月的随访中, 肌瘤体积显著缩小(51.6 ± 22.5 vs.33.4 ± 17.1mm³；p＜0.001)。12/20名患者(60%；p＝0.03)的三维超声彩色多普勒血管分布也显著减少(由同一操作员观察并由四名盲审员确认), 而报告的月经过多症状从18/20例(90%)减少至2/18例(10%；p＜0.01)。

结论: 宫腔镜激光消融术是在门诊治疗有症状的粘膜下肌瘤的一种可行而有效的替代方法。需要更大样本量和更长随访期的进一步研究来验证这一有前景的技术。

关键信息

• 这项试点研究表明, 门诊宫腔镜激光消融术(HLA)可以凝固子宫肌瘤的核心, 缩小肌瘤的体积并减少血管形成, 是治疗症状性粘膜下子宫肌瘤的可行替代方法。

Keywords:

• Hysteroscopic laser ablation
• three-dimensional sonography
• office myomectomy
• heavy menstrual bleeding
• hysteroscopy