Endoscopic management of fibromyomata

Abstract

Surgical endoscopy has been successfully utilised in most gynaecological conditions with reported benefits which include small scars, reduced hospital stay and early return to normal duties. Myomectomy with uterine conservation has been popularised since the 1930s. The relationship between symptoms, such as menorrhagia and the presence of uterine myomata, has still not been fully evaluated although it appears that there is a causal relationship when sub-mucous fibroids are present. In recent years, laparoscopy has been proposed as the access of choice to remove fibroids up to 10 cm in diameter. Concern and debate continue over the integrity of the scar produced and its strength in a future pregnancy. Pre-operative investigation to assess myoma position within the uterus varies from simple pelvic ultrasound, saline infusion sonography to magnetic resonance imaging (MRI). The technique of laparoscopic myomectomy also varies and different approaches are discussed here-in. Newer non-surgical techniques, such as uterine artery embolisation (UAE), are addressed. The true value of this approach is yet to be assessed as there are no randomised control trials (RCTs) comparing it with myomectomy. Hysteroscopic resection of sub-mucous fibroids is associated with a decrease in menstrual loss. A recent publication using truly evidenced-based medicine questions the accepted surgical tradition of treating fibroids even greater than 16-gestational weeks in size [Aust. N.Z. J. Obstet. Gynaecol. 2001 (41) 125].