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SURGERY

UTERINE FIBROIDS

We are a regional referral center for fibroid evaluation, treatment, and removal.  Uterine fibroids are quite common with 25-30% of women having a fibroid. Fortunately, most fibroids never lead to any problems. The vast majority of my patients with fibroids do not need any type of treatment, only reassurance. In the minority of women who have symptoms, some of the common complaints that result from problematic fibroids include heavy and uncomfortable menstrual periods, pelvic and abdominal pressure due to uterine enlargement, having to urinate more frequently, infertility and recurrent miscarriage.

In some cases, women with fibroids (also called myomas) are encouraged to undergo a hysterectomy when they actually want to conserve their uterus. It is very unlikely that if you have fibroids in your uterus that a conservative approach cannot be offered to you. If your physician only offers you a hysterectomy for your uterine fibroids and you still want to have a child, then you should call us for a second opinion consult or ask for a referral.

Myomectomy most often describes making an incision in the abdomen (similar to a cesarean section). The uterus is then opened and the fibroids are shelled out. The uterus is then carefully reconstructed. This technique has been around for decades and is an excellent option that should not compromise fertility in most cases.  In some cases, Doctors Smith and Williams can do the myomectomy through a small incision, called a mini-laparotomy or by a laparoscopy. This may allow discharge home the same day and a hospital stay is unnecessary.  Usually a 24-hour hospital stay is necessary with a myomectomy/

Some fibroids reside in the uterine cavity or have grown from the uterine wall into the uterine cavity which allows a minimally invasive approach called hysteroscopy. This is a wonderful option when available because it involves no incisions at all. During a hysteroscopic myomectomy a camera mounted on a 5 mm wide lens is inserted through the vagina and cervical canal into the uterus. Through the end of the lens specialized instruments are used to remove the fibroid(s).  Some practitioners do not offer a hysteroscopic approach to amenable fibroids. This is usually due to limited training but may also be because their operating room does not have the specialized equipment required to offer this technique.

In some circumstances we can offer a laparoscopic approach to myomectomy. This means that with a few 5 mm incisions in the abdomen the fibroids can be removed during a same-day procedure. No larger incision is required and the recovery is less than a week. Most physicians do not offer a laparoscopic approach to amenable fibroids. This is usually due to limited training but may also be because their operating room does not have the specialized equipment required to offer this technique.

Uterine Artery Embolization for fibroids (UAE) is another excellent minimally invasive technique for treating fibroids. However, radiologists and reproductive endocrinologists agree that this is often not the best option in someone who wants to get pregnant in the future. There is some information that the embolization can compromise ovarian function.  We do not recommend this technique unless you do not want to have a pregnancy in the future. To learn more about UAE go to: http://www.crlradiology.com.

MRI-focused ultrasound is another option.  It is a non-invasive approach to focus on ultrasound beams on the fibroid(s) to burn the tissue to cause it to shrink.  It has some of the same limitations as noted in with uterine artery embolization in women who wish to get pregnant.  The regional center for MRI focused ultrasound is at The University of Virginia, Department of Interventional Radiology.