Directed laparoscopic cryomyolysis: A possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas

Zupi, Errico; Piredda, A; Marconi, Daniela; Townsend, Duane E.; Exacoustòs, C.; Arduini, Domenico; Szabolcs, B.

doi:10.1016/j.ajog.2003.10.687

Cited by 55 publications

(31 citation statements)

References 12 publications

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“…A number of case series have been published supporting the feasibility of myoma ablation by either thermotherapy (bipolar or monopolar coagulation [12], diode laser [13][14][15][16], and radiofrequency [2,17]), cryotherapy [18][19][20], or focused ultrasound [21]. Compelling reasons for performing myolisis in patients who present with complaints of symptomatic myomas include the ease and rapidity of surgery, virtual lack of concern for hemostasis, less short-term morbidity than most surgical options, and rapid recovery.…”

Section: Discussionmentioning

confidence: 97%

“…Among the many techniques for in situ tissue destruction, RFA may be a better modality because it is fast, easy, predictable, safe, and relatively cheap. Radiofrequency energy is at least as effective as cryomyolysis in achieving myoma shrinkage [4,19], but it may offer potential advantages. First, the electrical generators required for RF ablation are considerably cheaper compared with cryosurgery equipment.…”

Section: Discussionmentioning

confidence: 98%

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Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas

et al. 2007

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas

et al. 2007

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“…Recent trend has been toward nonsurgical approaches such as GnRH hormone analogs/agonists, RU 486 [4] or selective uterine artery embolization [5], laparoscopic cryoablation [6,7], radiofrequency thermal ablation [8], and MRGUs [9,10]. Cervical fibroids are a separate class by themselves and account for 2-8 % of cases usually single.…”

Section: Risk Factorsmentioning

confidence: 99%

Clinicopathological Study of Uterine Leiomyomas: A Multicentric Study in Rural Population

Dutta²,

Dutta³

2015

J Obstet Gynecol India

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Background and Objectives Leiomyoma of uterus forms the most common type of benign tumor of uterus and also the most common pelvic tumor in women. The symptomatology continues to be variable. Surgery has for long been the main mode of therapy for the myomas. For women who wish to retain the uterus for future pregnancies or other reasons, myomectomy is preferred. Recent trend has been toward nonsurgical approaches like GnRH hormone analogs/agonists, RU 486, or selective uterine artery embolization, laparoscopic cryoablation, radiofrequency thermal ablation, and MRGUs. This multicentric study was an attempt to analyze the clinicopathological spectrum in cases of leiomyoma of the uterus at Cheluvamba Hospital, Adichunchanagiri Institute of Medical Sciences, and to know regarding the pattern of presentation, pathological correlation, with type of fibroid, and endometrial and ovarian changes. Results Leiomyoma is the most common benign tumor of the uterus and commonly affects the women of childbearing age, most commonly in the third decade, 55 %. The most common mode of presentation was menstrual disturbances (76 %), among which menorrhagia was seen in 54 % of the cases. Primary infertility was seen in 15 % of the patients. Intramural fibroids were the most common variety occurring in 60 % of the cases. Endometrial pattern was proliferative in 66.3 %. Cystic ovaries were seen in 8 % of the patients, adenomyosis in 16 % indicating hyperestrogenism. Conclusion Fibromyoma (leiomyoma) is the most common benign tumor of the pelvis. It commonly affects the women of child-bearing age, mostly in the third decade and is most commonly seen in multipara. The most common mode of presentation is menstrual disturbances. Intramural fibroid is the most common variety. The proliferative and hyperplastic endometrium was commonly reported. The presence of proliferative endometrium, adenomyosis, and cystic ovaries all are indicative of hyperestrogenic state associated with development of fibroids.

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“…It is not suggested that Coblation will replace other treatments such as gonadotrophin-releasing hormone analogues, 1 magnetic resonance imaging-directed cryotherapy, 2 directed laparoscopic cryomyolosis, 3 intranodal surgery with electromechanical tissue borer 4 and uterine artery embolisation. 5 A further two cases of myomectomy have been carried out using this equipment in this department, with similar results, which is encouraging.…”

Section: Discussionmentioning

confidence: 99%

Uterine myomectomy by Coblation

Langton

Timms

2006

BJOG

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A 33-year-old nulliparous woman presented to the gynaecology clinic with a 2-year history of heavy and painful periods. On pelvic examination, the uterus was thought to be 12-weeksize and irregular, suggesting fibroids. On ultrasound scan, the uterus was 12 · 7.7 · 7.8 cm. There was an area of mixed echogenicity on the anterior uterine wall measuring 8.4 · 7.4 · 7.8 cm, consistent with a fibroid. She was initially managed with tranexamic acid and mefenamic acid, but her periods continued to be heavy, and she developed symptoms of urinary urgency and frequency.Five months later, laparoscopy and hysteroscopy revealed a 16-week-size uterus with a large anterior wall fibroid and two small, right-sided subserosal fibroids. There was no evidence of endometriosis, and both tubes and ovaries were normal. The uterine cavity measured 14 cm and was distorted due to the presence of the large fibroid. She was offered myomectomy and made aware of the possible risk of hysterectomy.At laparotomy, she had a 10-cm left anterolateral myometrial fibroid, 3-cm right-sided subserosal fibroid and a 1-cm posterior subserosal fibroid. These were excised by Coblation (Figure 1). After adequate exposure of the uterus, the coblator was used to incise over the greater curvature of the myoma through the myometrium to the pseudocapsule of the lesion. The edges were grasped and retracted to enable tissue lysis between lesion and uterine muscle until sufficient tumour was exposed to allow insertion of a myoma screw. This allowed maximum distraction and exposure of the surgical plane. Most small vessels were coagulated without bleeding. Any larger, actively bleeding vessels were coagulated using the coagulation-only pedal, with simultaneous irrigation and suction delivered by the plasma wand, making identification of vessels easy and their coagulation accurate. This process was carried out in all directions, progressively freeing the tumour until total removal was achieved. The uterine wall was then reconstituted with interrupted sutures and the abdomen closed in layers with suction drainage. No haemostatic clamps were used and the endometrial cavity was not opened. Blood loss was recorded as 300 ml.Postoperatively, the suction drained 50 ml, but her haemoglobin dropped from 11.8 preoperatively to 9

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Directed laparoscopic cryomyolysis: A possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas

Cited by 55 publications

References 12 publications

Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas

Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas

Clinicopathological Study of Uterine Leiomyomas: A Multicentric Study in Rural Population

Uterine myomectomy by Coblation

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