Laparoscopic uterus sparing treatment of uterine fibroids

Czech version

Authors: K. Kubínová; M. Mára; M. Novotná; D. Kužel
Authors‘ workplace: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc.
Published in: Ceska Gynekol 2012; 77(4): 326-330

Overview

Objective:
To report up-to date knowledge on laparoscopic, uterine sparing treatment of uterine fibroids.

Study design:
Review.

Setting:
Uterine Fibroids Center, Department of Obstetrics and Gynecology, Charles University, Prague.

Methods:
Analysis of our clinical experience and available literature resources.

Results:
The management of uterine fibroids depends on the symptoms, location, and size of fibroids and on the reproductive plans of the patient. The surgical treatment has changed from laparotomy to minimally invasive surgery. In general, laparoscopic myomectomy (LM) is considered the best option in symptomatic patients with pregnancy plans. The laparoscopic approach is associated with lower postoperative morbidity as well as lower incidence of massive postoperative adhesion formation compared to laparotomy. The limitation of laparoscopic myomectomy is the size and the number of fibroids but also the location and the accessibility for the laparoscopic suturing. Laparoscopic uterine artery occlusion (LUAO) represents one of the alternatives to LM in patients with multiple small myomas or in patients with fibroids in unfavorable location. LUAO may be advantageously used prior to LM in order to reduce peroperative blood loss or to prevent the persisting fibroids from growing. However there is no universal treatment of uterine fibroids in fertile patients and in each single patient the indication and surgical method should be thoroughly considered.

Key words:
uterine fibroid, myomectomy, laparoscopy, uterine artery occlusion.

Sources

1. Agdi, M., Tulandi, T. Endoscopic management of uterine fibroids. Best Pract Res Clin Obstet Gynaecol, 2008, 22, p.707–716.

2. Buletti, C., Polli, V., Negrini, V., et al. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc, 1996, 3, p. 533–536.

3. Dubuisson, JB., Fauconnier, A., Deffarges, JV., et al. Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod, 2000, 15, p. 869–862.

4. Dubuisson, JB., Fauconnier, A., Fourchotte, V. Laparoscopic myomectomy: predictiong the risk factors of conversion to open procedure. Hum Reprod, 2001, 16, p. 1726–1731.

5. Hald, K., Noreng, HJ., Istre, O., Klow, NE. Uterine artery embolization versus laparoscopic occlusion of uterine arteries for leiomyomas: long-term results of a randomized comparative trial. J Vasc Interv Radiol, 2009, 20, p.1303–1310.

6. Holub, Z., Kliment, L. Laparoscopic ultrasonic dissection of uterine vessels in women with benign uterine pathologies. Clin Exp Obstet Gynec, 2002, 29, p. 54–56.

7. Holub, Z., Mára, M., Kužel, D., et al. Pregnancy outcomes after uterine artery occlusion: prospective multicentric study. Fertil Steril, 2008, 90, p. 1886–1891.

8. Holub, Z. Laparoskopická okluze děložních tepen. In: Mára, M. Děložní myomy. Praha: Grada Publishing, 2009, s. 138–144.

9. Hurst, BS., Matthews, ML., Marshburn, PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril, 2005, 83, p. 1–23.

10. Goldfarb, HA., Fanarjian, NJ. Laparoscopic assisted vaginal myomectomy: A case report and literature review. JSLS, 2001, 5, p. 81–85.

11. Chen, YJ., Wang, PH., Yuan, CC., et al. Pregnancy following treatment of symptomatic myomas with laparoscopic bipolar coagulation of uterine vessels. Hum Reprod, 2003, 18, p. 1077–1081.

12. Istre, O. Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy. Best Pract Res Clin Obstet Gynaecol, 2008, 22, p. 735–747.

13. Lethaby, A., Vollenhoven, B., Sowter, M. Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. BJOG, 2002, 109, p. 1097–1108.

14. Liu, WM. Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc, 2000, 7, p. 125–129.

15. Liu, WM., Ng, HT., Wu, YC., et al. Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids. Fertil Steril, 2001, 75, p. 417–422.

16. Liu, WM., Wang, PH., Chou, CS., et al. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas. Fertil Steril, 2007, 87, p. 356–361.

17. Mára, M. Laparoskopická myomektomie. In: Mára, M. Děložní myomy. Praha: Grada Publishing, 2009, s. 116–128.

18. Marret, H., Chevillot, M., Giraudeau, B. A retrospective multicentre study comparing myomectomy by laparoscopy and laparotomy in current surgical practice. What are the best patient selection criteria? Eur J Obstet Gynecol Reprod Biol, 2004, 117, p. 82–86.

19. Nezhat, C., Nezhat, FR., Silfen, S. Laparoscopic myomectomy. Int J Fertil, 1991, 36, p. 275–280.

20. Nezhat, C., Nezhat, F., Bess, O., et al. Laparoscopically assisted myomectomy: a report of a new technice in 57 cases. Int J Fertil, 1994, 39, p. 34–44.

21. Parker, W. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril, 2007, 87, p. 725–736.

22. Pellicano, M., Bramante, S., Cirillo, D., et al. Effectiveness of autocrosslinked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study. Fertil Steril, 2003, 80, p 441–444.

23. Seracchioli, R., Rossi, S., Govoni, F., et al. Fertility and obstetrics outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod, 2000, 15, p. 2663–2668.

24. Siedman, DS., Nezhat, CH., Nezhat, F., Nezhat, C. The role of Laparoscopic-Assisted Myomectomy (LAM). JSLS, 2001, 5, p. 299–303.

25. Stewart, L., Glenn, GM., Stratton, P., et al. Association of germline mutations in the fumarate hydratase gene and uterine fibroids in women with hereditary leiomyomatosis and renal cell cancer. Arch Dermatol, 2008, l44, p. 1584–1592.

26. Tsuji, S., Takahashi, K., Yomo, H., Fujiwara M., et al. Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol, 2005, 123, p. 244–248.

27. Wang, CJ, Yen, CF, Lee, CL., et al. Laparoscopic-assisted vaginal myomectomy. J Am Assoc Gynecol Laparosc, 2000, 7, p. 510–514.