Interstitial laser photocoagulation for uterine myomas☆,☆☆
Section snippets
Patients and methods
Twenty-four patients with symptomatic myomas who declined open myomectomy or hysterectomy were recruited from the Elizabeth Garrett Anderson Hospital in a study that was approved by the ethics committee of the University College London Hospitals. Lesions were assessed by magnetic resonance imaging (MRI) or ultrasound scans with a hysteroscopy to exclude submucous myomas.
Optical fibers were prepared by sterilization and precharring of the fiber tip. Treatments were carried out at laparoscopy
Results
Thirty myomas (median diameter, 5 cm) were treated in 24 patients (age, 26-51 years) with 1 to 4 fibers and 1 to 8 treatment sites per patient. All patients expressed satisfaction with the treatment, recovery, and return to normal activity and had no more discomfort than after a diagnostic laparoscopy, making day case treatment appropriate.
Twelve patients were assessed with ultrasound scanning. By 6 months, 9 of 11 myomas followed up had shrunk (3 lesions were undetectable). Twelve patients had
Comment
This study shows that ILP is a safe, well-tolerated procedure that can shrink uterine myomas. Although our aim was to document the response of individual myomas, more than one half of those patients with menorrhagia benefitted. Failures were in the 3 largest myomas (>9 cm) and those attributable to remediable technical problems (inadequate precharring). Myomas swelling soon after ILP had the greatest long-term shrinkage, so failure to swell could be an indication for early retreatment. Major
Acknowledgements
We thank our colleagues Mr Alisdair Gordon, Mr Mark Broadbent, and Dr Sandy Mosse for their support.
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2007, Journal of Vascular and Interventional RadiologyLaparoscopic radiofrequency thermal ablation: A new approach to symptomatic uterine myomas
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2004, Reviews in Gynaecological PracticeDirected laparoscopic cryomyolysis: A possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas
2004, American Journal of Obstetrics and GynecologyCitation Excerpt :It is possible that as we treat larger myomas, some patients may have some of the side effects noted with UAE. Other options available for the conservative treatment of myomas are thermoablation, and MRI-guided cryotherapy.15–17 It is well known that thermoablation carries significant risks related to the extent of tissue damage caused by monopolar energy.18
What's new in gynecology and obstetrics
2003, Journal of the American College of Surgeons
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Supported by the Special Trustees of the Elizabeth Garrett Anderson Hospital and the Peacock Trust.
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Reprints not available from the authors.