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New Procedure Can Help Fibroid Tumor Patients Avoid Hysterectomy

Women who suffer from benign uterine fibroids usually face hysterectomy. A new, minimally invasive procedure called laparoscopic myolysis may prevent most benign fibroid patients from undergoing hysterectomy and losing their ability to have children.

The procedure was discussed at the Symposium on Current Issues and New Techniques in Gynecology in San Francisco on Friday, July 26. According to scientists at the symposium, the impact of laparoscopic myolysis will be profound. In the U.S. alone, approximately 600,000 hysterectomies are performed every year–about 240,000 of these are done to remove benign fibroids. The new technique can prevent anywhere from half to three-quarters of such hysterectomies.

Laparoscopic myolysis is a two-stage process. The patient is given three monthly injections of a drug that shrinks fibroids. This is done to test whether laparoscopic myolysis would be effective, according to Dr. Mark Glasser, chief of obstetrics and gynecology at Kaiser Permanente in San Rafael, California. Fibroids that have become firmer and calcified with the passage of time will not respond well to the drug. But, Glasser explains, “If the drug is effective, we know the procedure will be too.”

The surgical portion of the technique follows. An incision is made in the navel and a slim laparoscope is inserted that enables the physician to see the fibroids in the uterus. Then, lasers or electrodes are inserted through one to three more incisions in the abdomen, and energy is applied to the fibroids to shrink them.

Shrinkage is dramatic. Glasser has seen melon-sized fibroids reduced to the size of a grapefruit. The fibroid may be reabsorbed by the body after reduction or may simply be small enough to cause no further problems. The procedure also helps to control excessive bleeding caused by fibroids.

Recovery is fast compared to the four days of post-operative hospitalization for hysterectomy, with six to eight weeks of home rest for full recovery. Laparoscopic myolysis is outpatient surgery; the patient is home in four hours and fully able to resume normal activity in one or two weeks.

Fertility appears to be protected by laparoscopic myolysis, at least in early studies, but the position and number of fibroids play a part in whether reproductive function will be normal following the procedure. Dr. Douglas Phillips, a physician and researcher at the State University of New York Medical School, Stony Brook, New York, helped to improve and standardize the technique after its introduction in the late 1980s.

Phillips says that scar tissue is minimal with this procedure and feels that it will not interfere with fertility. The United States reports a success rate of five post-operative births. The United Kingdom has shown a 40% conception rate after laparoscopic myolysis, and Australia’s figure is 20%.

But, if the fibroids are numerous or are near the Fallopian tubes, reproductive function may not be preserved by this technique.

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