Interstitial laser photocoagulation for uterine myomas

doi:10.1067/mob.2002.123892

American Journal of Obstetrics and Gynecology

Volume 187, Issue 2, August 2002, Pages 382-384

https://doi.org/10.1067/mob.2002.123892 Get rights and content

Abstract

Thirty myomas in 24 symptomatic patients who refused conventional surgery were treated by interstitial laser photocoagulation, monitored by laparoscopy. The procedure was well tolerated. Magnetic resonance imaging or ultrasound scanning documented shrinkage in 23 lesions (those lesions >6 cm in diameter responded poorly), with clinical benefit in 13 patients. (Am J Obstet Gynecol 2002;187:382-4.)

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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Percutaneous Image-guided Radiofrequency Thermal Ablation for Large Symptomatic Uterine Leiomyomata after Uterine Artery Embolization: A Feasibility and Safety Study
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To evaluate the feasibility and safety of percutaneous image-guided radiofrequency ablation (RFA) performed with moderate sedation for large symptomatic uterine leiomyomata.
Women with large (>5 cm in diameter) symptomatic subserosal and/or intramural uterine leiomyoma were recruited for a prospective study. Patients underwent percutaneous RFA following UAE. RFA using 5 cm treatment diameter expandable needle electrodes connected to a 460 kHz monopolar RF generator, which was performed with a target temperature and power set at 85°C and 150 watts respectively, with a target temperature ablation time of 10 minutes. Patients were assessed for complications in perioperative and post-procedure periods at 24 hours and 1 month, and for symptom improvements at 6 months.
Thirty-five patients (mean 43.8 years ± 6.2) were recruited. RFA targeting ablation size and temperature was achieved in 97% of the patients (34/35). There were no immediate percutaneous RFA-related complications. There was a self-limiting delayed drainage via the transabdominal RFA access track in one patient (2.9%), a urinary tract infection in one patient (2.9%) and post-embolization/post-ablation symptoms in three patients (8.6%). The mean transformed symptom severity score (SSS) as a part of the uterine fibroid symptom and quality of life (UFS-QOL) assessment shows that the improvements at 1 month were 24.3 points (P < 0.001) and at 6 months were 40.4 points (P < 0.001). Mean volume reduction of leiomyomata was 286.8 cm³ or 56.5% (P = 0.0015).
Percutaneous image-guided RFA as adjunctive to UAE under moderate sedation is feasible, and appears safe without significant morbidity in the treatment of large uterine leiomyomata.
Laparoscopic radiofrequency thermal ablation: A new approach to symptomatic uterine myomas
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The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic radiofrequency ablation of uterine fibroids.
Eighteen women with symptomatic intramural uterine myomas underwent radiofrequency ablation under laparoscopic guidance. Postoperative sonographic evaluations of the fibroids size were scheduled at 1, 3, 6 ,9, and 12 months. The impact of myoma-related symptoms on quality of life (QOL) was assessed using a validated questionnaire.
The median number of myomas treated per patient was 1 (1-3). The median baseline volume of the dominant myoma was 67.2 cm³ (14.8-332.8). No intraoperative or postoperative complications occurred. The median reductions in myomas volume were 41.5%, 59%, and 77% at 1, 3, and 6-months, follow-up evaluation, respectively. No further change in fibroid size was observed at 9 months and 1 year. A significant improvement in the symptoms score and QOL score was observed at 3 and 6 months, follow-up.
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The conventional surgical treatment for women with symptomatic uterine fibroids is a hysterectomy. Hysterectomy guarantees the removal of all uterine fibroids without a risk of recurrence. It also guarantees the cure of symptoms such as menorrhagia and pressure effects and has been shown to be associated with a high degree of patient satisfaction and improved quality of life scores. However, in addition to women who desire fertility, there are a growing number of women who have completed their family who do not wish to undergo a hysterectomy. Uterine conserving surgical methods include myomectomy or fibroid shrinkage either by embolisation/laparoscopic clipping of both uterine arteries or myolysis.
This article reviews the surgical alternatives to hysterectomy and analyses the data that is currently available with each method. Laparoscopic interstitial laser photocoagulation of uterine fibroids is a relatively new modality of treatment and is carried out in our centre. Results of this method are presented and discussed in this article.
Myomectomy is associated with significant morbidity and difficulty in long term management because of high recurrence rates. Surgical alternatives to myomectomy are still limited to large series in a few centres with a special interest in the procedure developed. Well designed long term studies are required to properly evaluate the efficacy and feasibility of each procedure in normal practice and its effect on infertility.
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Citation 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
The purpose of this study was to develop a minimally invasive, safe, and effective technique for managing symptomatic uterine myomas.
Twenty patients with symptomatic uterine fibroids were treated. All had complaints of abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters were 4 to 8 cm. Power color Doppler imaging was performed preoperatively and postoperatively to determine the effectiveness of cryomyolysis in reducing or eliminating the primary blood supply, as well as regression of the myomas. Laparoscopic cryomyolysis was performed with use of the Her Option Cryoablation System (American Medical Systems Gynecology, San Diego, Calif). Patients were evaluated at 1, 3, and 6 months postoperatively.
All patients were discharged within 24 hours of treatment. No intraoperative or postoperative complications occurred. Of the 20 patients treated, 19 had complete resolution of their complaints. Myomas regressed up to 80%, and major blood supply to the myomas was eliminated.
Directed laparoscopic cryomyolysis is an effective and safe technique for symptom relief from leiomyomas.
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^☆: Supported by the Special Trustees of the Elizabeth Garrett Anderson Hospital and the Peacock Trust.

^☆☆: Reprints not available from the authors.

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Interstitial laser photocoagulation for uterine myomas☆,☆☆

Abstract

Section snippets

Patients and methods

Results

Comment

Acknowledgements

Breast

Magnetic resonance-guided percutaneous laser ablation of uterine fibroids

J Magn Reson Imaging