Our Summary

This research paper is about a common benign (non-cancerous) pelvic tumor called submucosal uterine leiomyomas, which can cause abnormal bleeding from the uterus and may lead to infertility and miscarriage. The preferred treatment for these tumors is a procedure called hysteroscopic myomectomy, which can control the bleeding and normalize the uterus.

The authors discuss the two main surgical tools used in this procedure: the bipolar resectoscope and the hysteroscopic mechanical morcellator. Both tools are effective in removing the tumors.

The hysteroscopic morcellator is associated with a shorter surgery time and easier learning curve for surgeons, but data is limited for its use on a certain type of fibroids. On the other hand, the bipolar resectoscope is particularly good at removing deeper, type 2 fibroids.

The conclusion is that there isn’t a one-size-fits-all technique. The choice of surgical tool should be made on a case-by-case basis, depending on factors such as the number, size, type, and location of the tumors. It’s important that gynecologists are knowledgeable about each technique and its associated risks to ensure safe surgeries for their patients.

FAQs

  1. What is the preferred treatment for submucosal uterine leiomyomas?
  2. What are the two main surgical tools used in hysteroscopic myomectomy and what are their differences?
  3. How is the choice of surgical tool for hysteroscopic myomectomy determined?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss with them the different surgical tools that can be used and how the choice of tool can depend on the specific characteristics of the fibroids being removed. It’s important for the patient to be informed about the different options available and to have a thorough discussion with their doctor to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended myomectomy are those with submucosal uterine leiomyomas causing symptoms such as abnormal bleeding, pelvic pain, infertility, and recurrent miscarriages. These patients may have failed conservative treatments such as medication and hormonal therapy and are seeking a more definitive solution to their symptoms. Additionally, patients who desire to preserve their fertility or avoid a hysterectomy may also be recommended myomectomy as a treatment option. It is important for patients to consult with their gynecologist to determine if myomectomy is the appropriate treatment for their specific condition.

Timeline

Before myomectomy:

  1. Patient experiences symptoms such as abnormal uterine bleeding, pelvic pain, and infertility.
  2. Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of submucosal uterine leiomyomas.
  3. Patient consults with a gynecologist to discuss treatment options, including myomectomy.
  4. Patient may undergo preoperative testing and evaluation to ensure they are a suitable candidate for surgery.

After myomectomy:

  1. Patient undergoes hysteroscopic myomectomy procedure to remove the submucosal uterine leiomyomas.
  2. Recovery period following surgery, which may include pain management, monitoring for complications, and restrictions on physical activity.
  3. Patient may experience relief from symptoms such as abnormal bleeding and pelvic pain.
  4. Follow-up appointments with the gynecologist to monitor recovery and address any concerns.
  5. Patient may experience improved fertility outcomes and reduced risk of miscarriage following successful removal of the tumors.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a myomectomy procedure?
  2. What is the success rate of hysteroscopic myomectomy for treating submucosal uterine leiomyomas?
  3. How long is the recovery time after a myomectomy procedure?
  4. What are the chances of the fibroids recurring after a myomectomy?
  5. How will my fertility be affected by the myomectomy procedure?
  6. Will I still be able to have children after a myomectomy?
  7. Are there any alternative treatment options for submucosal uterine leiomyomas?
  8. How experienced are you in performing hysteroscopic myomectomy procedures?
  9. What type of fibroids do I have and which surgical tool would be most effective for removing them?
  10. What are the long-term effects of having a myomectomy procedure?

Reference

Authors: Friedman JA, Wong JMK, Chaudhari A, Tsai S, Milad MP. Journal: Curr Opin Obstet Gynecol. 2018 Aug;30(4):243-251. doi: 10.1097/GCO.0000000000000475. PMID: 29939852