What is a Fibroid?
Fibroids are benign, firm tumors that grow on or in the uterine walls, made up of smooth muscle cells and fibrous connective tissues. They are also called leiomyomas or myomas. Fibroid sizes vary from small ones under 1 cm (1/3 inch) to the large ones exceeding the size of a watermelon, weighing several pounds.
Fibroids also vary in symptoms depending on their size and location. When found inside the uterine cavity (sub-mucosal fibroids), they often produce heavy and irregular bleeding even when with they are as small as 1-2 cm. Sub-mucosal fibroids are also very likely to cause infertility. On the other hand, if fibroids are found on the outer surface of the uterus (sub-serosal fibroids), they may grow to 10 cm – 15 cm size without causing any significant symptoms.
Treatment
The mainstay of fibroid treatment is surgical. While there are some medications that can temporarily decrease the size of fibroids, there are no effective long-term medical treatments. Below, we will describe most of the effective techniques in treating uterine myomas.
Continuous Innovation and Extensive Experience
At Bess Women’s we treat thousands of women with fibroids. Dr. Oleg Bess has completed a Minimally Invasive fellowship with Society of Reproductive Surgeons, where he specifically trained in fibroid surgery, performing hundreds of procedures. Dr Bess, along with Drs Nezhat published a paper where they described a new procedure which they developed - Laparoscopically Assisted Myomectomy (LAM). (See the full description below) Based on the experience of treating thousands of patients, we work with you to select the most appropriate course of treatment for YOU.
Vaginal Approach (Least Invasive)
This treatment depends on the fibroid location and its size. Sub-mucosal fibroids, while the most likely to cause bleeding or infertility, can usually be removed with the least invasive technique vaginally. This procedure is called hysteroscopy and the instrument that shaves the fibroid away is called a resectoscope. We also commonly use other vaginal instruments that vaporize fibroids such as Endosure or Hydro-thermal Ablation (HTA). All of these techniques use vaginal access to fibroids and patients are usually able to return to work within 1-2 days.
Recovery time: 1-2 days, incision size: NONE
Uterine Artery Embolization (UAE)
While this procedure is usually performed by an Interventional Radiologist, there are some Gynecologists that are specifically trained to perform this procedure. During this procedure, a catheter is passed through the groin artery into the uterine artery. Special foam is delivered through the catheter into the uterine artery, blocking the blood flow to the fibroids. As the blood supply is reduced or completely stopped, the fibroid tissue decomposes, causing a reduction in size. This process of tissue decomposition also causes severe abdominal pain for 1 -2 weeks after the procedure. UAE recovery is rapid, lasting a few days, with the abdominal pain persisting much longer. While the chance of the fibroid to become cancerous is highly rare, some gynecologists also recommend a laparoscopic biopsy before the UAE. Of course, the laparoscopy itself adds to the total recovery time.
Recovery time: 1-2 days, incision size: small puncture in groin
Laparoscopic Myomectomy
Laparoscopy is a procedure where only small punctures are made on the abdomen with one of the punctures usually located in the belly button (umbilicus). The recovery is relatively rapid after a laparoscopic procedure, returning to work within 1-2 weeks. However, laparoscopy is usually reserved for smaller, sub-serosal fibroids. If the fibroid is located deeper in the muscle of the uterus, after the myoma is removed, the uterus needs to be carefully repaired with sutures. Suturing with laparoscopy is a very demanding process and is difficult to perform carefully and in multiple layers, as required for good healing.
Recovery time: 1 – 2 weeks, max incision size: 1.2 cm
Robotic Myomectomy
Robotic surgery is similar to laparoscopy, however, instead of the surgeon manipulating the instruments directly, a robot is positioned over a patient and the surgeon sits in a control pod. Robotic technique has a number of advantages, allowing the surgeon superior visualization and dexterity. Utilizing robotics, a surgeon can repair the uterus in multiple layers with suturing. There are however size limitations. Some of the larger fibroids are still not reasonable to remove with the robotic technique.
Recovery time 1 – 2 wks, max incision size 2 cm
Conventional Myomectomy
This procedure is performed through a bikini incision that is approximately the size of a c-section. This procedure can be used to remove even the largest fibroids. However, when fertility is required, it is more difficult to examine the pelvis for other problems such as endometriosis or pelvic adhesions.
Recovery time: 4 – 6 wks, max incision size 12 – 16 cm
Laparoscopically Assisted Myomectomy (LAM)
This procedure combines most of the advantages of laparoscopy and conventional myomectomy. A very small (4 cm or 1.5 inch) bikini incision is added to the laparoscopic approach. This allows the surgeon to both remove even the largest fibroids as well as carefully suture the incision. The laparoscopic portion of the procedure allows the surgeon to examine and treat other problems that are identified in the abdomen. This procedure is highly recommended to those whose main concern is future fertility or those with large myomas who must return to work in half-the-time of a conventional myomectomy.
Recovery time: 3 – 4 wks, incision size 4 cm
Dr. Oleg Bess was one of the original authors of LAM in 1993. Since that time he performed hundreds of LAMs and other types of myomectomies. After the LAM publication in 1993, thousands of other doctors learned this innovative technique.
Laparoscopically assisted myomectomy: a report of a new technique in 57 cases.
Nezhat C, Nezhat F, Bess O, Nezhat CH, Mashiach R, Int J Fertil Menopausal Stud. 1994 Jan-Feb; 39(1):39-44.
Hysterectomy
This procedure is designed to remove a uterus when the patient is no longer concerned with future fertility. A hysterectomy can be done laparoscopically, robotically, or through a conventional bikini incision. As with a myomectomy, the technique is chosen based on the size of the fibroids, as well as numerous other criteria.
