• 16 SEP 13
    • 0

    Until recently, the only option in a case of symptomatic uterine fibroids was classical surgery by laparotomy (incision of the abdominal wall). Acquisitions in recent years in the pharmaceutical industry and medical technology have greatly expanded the range of options and made possible, in many cases, the resolution of symptoms due to fibroids while preserving reproductive and menstrual function of the uterus.

    One of the most modern treatment methods is the laparoscopy, laparoscopic approach involves replacing classical incision with a series of small incisions, 5-12 mm. in which operations are performed using special instruments and a camera to track the evolution of screen procedure. Laparoscopy has many gynecologic surgery indications, the land is at least as broad as that of biliary surgery. Ovarian cysts, ectopic pregnancy, tubal infertility cause, endometriosis can be solved successfully by laparoscopy. Recently, laparoscopy has become useful in gynecologic oncology for staging cancer or pelvic lymph node removal (lymphadenectomy). Regarding uterine fibroids, laparoscopy is indicated so when seeking removal of a node that protrudes outside petetelui cancer (laparoscopic myomectomy), and for removal of the uterus entirely when this intervention is indicated (laparoscopic hysterectomy). the advantages are that way laparoscopic abdominal wall remains intact (recovery and social reintegration faster than the classical pathway, the significant reduction in the risk of postoperative hernia) and dramatically decreases the risk of postoperative adherents syndromes.

    Another useful endoscopic technique in the treatment of uterine fibroids is hysteroscopy, a technique that involves interventions made ​​through a cannula inserted under direct visualization utero. Hysteroscopy allows extracting fibroid nodules that protrude into the uterine cavity, which is manifested by heavy bleeding, or loss infertiliate recurring tasks. Advantages of hysteroscopy are important: not cut the abdominal wall (with benefits above) and perhaps more importantly, it is sectioned uterine wall, which increases the chances of achieving a pregnancy, the pregnancy to term and give birth naturally. Recovery is also much faster than the classical pathway interventions performed.

    Endoscopic techniques have therefore undeniable advantages. They assume, however, that there equipment (quite expensive) and special training of surgeons in these techniques.

    Hormonal therapy also has particular indication in patients who are approaching menopause or. Involution hormone fibroids but will be closely monitored by ultrasound and clinical controls.

    Another modern technique is uterine fibroid embolization treatment. This involves blockage of vessels that feed fibroid nodules after radiological visualization of these vessels. After the dishes are not permeable, greatly reducing their size fibroid nodules and symptoms caused by fibroids diminish or even disappear. The main indication of this technique is uterine fibroids located in the uterus grosmea (ie inaccessible by endoscopic techniques described above) in young women who desire a pregnancy). The disadvantages of the method consists in a significant incidence of potentially severe complications and poor accessibility of the method (not available except in large centers, laboratory equipped with angiography).

    In recent years the classic surgical technique evolved approach to fibroids multiplying the cases in which only remove fibroids, fibroids in the uterus, the body maintains the place recommended method especially in young people for the integrity of the uterus is required in order to any task. Another direction of evolution is the transvaginal surgery involving about transvaginal uterine ablation without any incision. Removing any postoperative complications related to the evolution of short-term and especially long wound is a great advantage especially in obese individuals. Technique, although not new, knows is a strong, more and more patients benefiting from the advantages of the method. Some of them early mobilization after surgery, reduced pain and shorter hospital stay 1-2 days.

    To indicate one of the methods mentioned is obviously required a thorough gynecologic consultation and perform a set of analyzes and laboratory explorations. Discussion of various options with the patient is also very important, a complete understanding of all aspects of the process chosen by the patient is one of the concerns of the examining doctor.

    The most important thing is that the female population to realize the importance of addressing a gynecologist if there is suspicion of a diagnosis of fibroids you for appropriate treatment as well as to diagnose another condition which, although they have a number of symptoms similar, may have a less favorable prognosis in case of late diagnosis, it is especially malignant diseases of the uterus.

    Gynecological examination performed regularly at six months, is the most reliable method to diagnose early and treat any disease, including uterine fibroids, thus preserving patient complications that may occur with increase in size of the fibroids.

     

    Dr. Alina Ursuleanu, Obstetrics and Gynecology, Assistant Professor, MD

    Proestetica Medical Center Bucharest

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