Fibroid are benign (non-cancerous) tumours, which grow on, or in, the muscle lining of the uterus.
Uterine fibroids (leiomyomata) are the most common benign tumours, occurring in 70% of white women and 80 % of black women by the time they reach 50 years of age and the myomas are clinically apparent in 25% of patients. Smooth muscle tumours of the uterus cover a broad spectrum, from benign leiomyomata to leiomyosarcomata. Within this spectrum lies STUMP- smooth muscle tumours of unknown malignant potential. Leiomyosarcomas account for 3-7% of malignant disease of the uterus. They are found in about 0.5% of women who have hysterectomies for fibroids. They are the most common sarcoma (accounting for 25-36% of uterine sarcomas).
There are three different types of fibroids, submucosal, intramural and subserosal:
Most uterine fibroids are asymptomatic. They are usually only discovered in the course of clinical or imaging investigation of other conditions. There are no confirmed risk factors, however, it is known that
Symptoms of fibroids can be:
Hysteroscopic morcellation is achieved by using a probe with a ‘uterine shaver’. Once placed inside the uterine cavity, the device shaves off and immediately suctions out any excised tissue that might impair visibility. The ability to remove and instantly suction out tissue fragments means the hysteroscope and morcellator are inserted only once, for initial entry.
For the physician, the immediate removal of tissue through the probe makes surgery much simpler to perform and requires less surgical time.
Traditionally, the removal of fibroid has involved a laparotomy under general anaesthesia but this technique is becoming increasingly unpopular and new technological developments now permit the procedure to be performed quickly and safely hysteroscopically under local anaesthesia in an ambulant setting.
Data from the 2010 Office of National Statistics (ONS) reports that there are 20,500.913 woman aged between 15-64 years of age in the UK. It is estimated that 3.4 million women develop fibroids and 850,000 of these women are anticipated to seek treatment. Taking into account an estimated 22,750 women who undergo major surgery of a hysterectomy directly due to fibroids and discounting a percentage of 55% of hysterectomies performed for intramural fibroids and 40% of subserosal fibroids that cannot be treated by hysteroscopic morcellation, there is an estimated 35,000 woman that could undergo hysteroscopic morcellation with the emphasis to move more minimally invasive procedures to the outpatient environment.
In the UK, polyps and small fibroids are commonly treated by Wire Loop resection as it is a cost-effective and multi-use system. Women are most commonly prescribed birth control treatment if suffering from abnormal uterine bleeding, or even referred for a hysterectomy (an estimated 38%of hysterectomies are directly related to fibroids in a clinical study led by Vassey in 1992).
3.1 Hormone Therapy
In mild cases of uterine fibroids, it is common for doctors to prescribe hormone therapy. Altering oestrogen levels with the assistance of medication may reduce fibroid clusters in some women, though this method is not successful with every patient. Also, successful hormone therapy may not be a permanent solution. Many documented cases have indicated a fibroid regrowth shortly after the completion of hormone therapy. Medication can be administered orally or via an intrauterine device.
Endometrial resection can be used to physically remove fibroids. This method of treatment has declined somewhat in popularity due to competition from UAE, which is less invasive.
Forceps and graspers are a cheaper cost option with less equipment required. MyoSure does require inflow/suction while most physicians will blindly go in with forceps to try to remove polyps and small fibroids. But the limitations on these manual instruments is the risk of perforation and the challenge of removing large pathology through the cervix, which could lead to longer, if not incomplete, procedures, in addition to the high percentage of missed pathology.
The bipolar Vaporisation technique is a quicker procedure than the standard mono/bipolar loop. However, it is dependent on the size of pathology and is slow in removing fibroids and larger pathology. Also, as tissue is vaporized, there is no pathology able to be investigated.
The MyoSure Tissue Removal System is a new and innovative treatment that is designed to provide incision-less, fast and safe removal of intracavitary fibroids and polyps and effective relief of the associated abnormal uterine bleeding symptoms. The MyoSure Tissue Removal System provides a treatment option for women seeking to preserve uterine form and function. The easy-to-use device is designed to provide gynaecologists with confidence and control via a minimally-invasive care option for their patients. Clinical studies show the efficacy rate for hysteroscopic removal is very high at 96.4%of patients of symptom resolution and less than 10% recurrence at five years.
The bespoke polyp and fibroid removal system uses a mechanical mechanism of action and has a proprietary blade, with a unique side window, that simultaneously rotates and reciprocates at 6,000 rotations (1.5g) per minute, enabling fast tissue cutting from any location within the uterus and intact tissue margins on the specimen.
Facilities to perform a morcellation procedure
Necessary equipment and supplies:
• Performed in an outpatient setting
MyoSure has been especially created for use in an outpatient setting.
• Fluid management systems
MyoSure is compatible with all fluid management systems.
• Efficacy rates for hysteroscopic removal is very high
Clinical studies show the efficacy rate for hysteroscopic removal is very high at 96.4% of patients of symptom resolution and less than 10% recurrence at five years.
Treatment of all of the above should be conservative, medical, radiological, ssurgical various type of surgical methods using Laser and Hysteroscopic removal using different technique including the latest technique of My-Sure tissue removal (Tissue Morcellation) , Myomectomy of Intramural Fibroid should be avoided in a women trying to conceive or they did not complete their family, but subserous Myomectomy could be removed if it is causing pressure symptoms, but for other symptoms removing subserous fibroid usually do not improve symptoms of menorrhagia or recurrent miscarriage or improve fertility.
We are at Queensway Clinic totally against Myomectomy as we have seen over the years many patients with severe pelvic adhesions, Tubal block, Infertility problems, pelvic pain and deep dyspareunia (Painful Sex) as a result of Surgical Myomectomy .
Multiple Fibroid uterus size of twenty weeks or 5 month pregnancy, removed through Bikini incision. 52 years old woman complaining of severe long and heavy period with pressure symptoms. After excluding uterine pathology other than Fibroids, we carried out Subtotal Hysterectomy & Removal of both ovaries and tubes, to be followed by HRT.
Cervix was left on patient’s request for sexual gratification.
Patient will be seen regularly for smear test.
Laparoscopic view of fundal fibroid, patient bleeding heavyily during period, also wish to have a baby and trying for 10 years.
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