Laparoscopically assisted uterine fibroid cryoablation

Pansky, Moty; Cowan, Bryan D.; M, Frank; Hampton, Harriette L.; Zimberg, Stephen

doi:10.1016/j.ajog.2009.06.028

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…A number of focused energy delivery systems have been tested in the past decade including those based upon radiofrequency electricity, supercooled cryoprobes, and most recently, MRg-FUS or high frequency ultrasound guided transcutaneous focused ultrasound ablation. [182][183][184][185] A major disadvantage of all systems and techniques used to desiccate or ablate fibroids may be that they treat one fibroid at a time and they target the centre of fibroids, while fibroids have been shown to grow mostly from their periphery. 186 These technologies are relatively new and although many are promising, they often lack long-term data, which interferes with our ability to present all risks and benefits with assurance.…”

Section: Focused Energy Delivery Systemsmentioning

confidence: 99%

The Management of Uterine Leiomyomas

Vilos

Allaire

Laberge³

et al. 2015

Journal of Obstetrics and Gynaecology Canada

418

274

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The quality of evidence in this document was rated using the criteria described in the Report of the Caadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. Uterine fibroids are common, appearing in 70% of women by age 50; the 20% to 50% that are symptomatic have considerable social and economic impact in Canada. (II-3) 2. The presence of uterine fibroids can lead to a variety of clinical challenges. (III) 3. Concern about possible complications related to fibroids in pregnancy is not an indication for myomectomy except in women who have had a previous pregnancy with complications related to these fibroids. (III) 4. Women who have fibroids detected in pregnancy may require additional maternal and fetal surveillance. (II-2) 5. Effective medical treatments for women with abnormal uterine bleeding associated with uterine fibroids include the levonorgestrel intrauterine system, (I) gonadotropin-releasing hormone analogues, (I) selective progesterone receptor modulators, (I) oral contraceptives, (II-2) progestins, (II-2) and danazol. (II-2) 6. Effective medical treatments for women with bulk symptoms associated with fibroids include selective progesterone receptor modulators and gonadotropin-releasing hormone analogues. (I) 7. Hysterectomy is the most effective treatment for symptomatic uterine fibroids. (III) 8. Myomectomy is an option for women who wish to preserve their uterus or enhance fertility, but carries the potential for further intervention. (II-2) 9. Of the conservative interventional treatments currently available, uterine artery embolization has the longest track record and has been shown to be effective in properly selected patients. (II-3) 10. Newer focused energy delivery methods are promising but lack long-term data. (III) Recommendations 1. Women with asymptomatic fibroids should be reassured that there is no evidence to substantiate major concern about malignancy and that hysterectomy is not indicated. (III-D) 2. Treatment of women with uterine leiomyomas must be individualized based on symptomatology, size and location of fibroids, age, need and desire of the patient to preserve fertility or the uterus, the availability of therapy, and the experience of the therapist. (III-B) 3. In women who do not wish to preserve fertility and/or their uterus and who have been counselled regarding the alternatives and risks, hysterectomy by the least invasive approach possible may be offered as the definitive treatment for symptomatic uterine fibroids and is associated with a high level of satisfaction. (II-2A) 4. Hysteroscopic myomectomy should be considered first-line conservative surgical therapy for the management of symptomatic intracavitary fibroids. (II-3A) 5. Surgical planning for myomectomy should be based on mapping the location, size, and number of fibroids with the help of appropriate imaging. (III-A) 6. When morcellation is necessary to remove the specimen, the patient should be informed about possible risks and complications, including the fact that in rare cases fibroid(s) ma...

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Section: Focused Energy Delivery Systemsmentioning

confidence: 99%

The Management of Uterine Leiomyomas

Vilos

Allaire

Laberge³

et al. 2015

Journal of Obstetrics and Gynaecology Canada

418

274

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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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“…A comparable method, cryomyolysis or cryoablation, uses a freezing probe with similar effects. Laparoscopic‐assisted cryoablation demonstrably decreases leiomyoma volume over preprocedure volumes at both 6 and 12 months postprocedure (43.3% and 66.4%, respectively) while simultaneously improving health‐related quality of life during these same time points (61.9% and 66.7%, respectively) 24 . Despite these positive results, research comparing myolysis to other leiomyoma treatments is lacking, and research evaluating the long‐term effectiveness is insufficient.…”

Section: Treatmentmentioning

confidence: 99%

Etiology, Diagnosis, and Management of Uterine Leiomyomas

Rice¹,

Secrist²,

Woodrow³

et al. 2012

J Midwife Womens Health

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Uterine leiomyomas are the most common benign gynecologic tumors. While the true etiology of leiomyomas remains unknown, their origin is thought to be multifactorial including genetic, hormonal, and tissue growth factor variations. Leiomyomas are predominantly found in women of reproductive age and are the leading indication for hysterectomy worldwide. Menstrual irregularities, pain, and fertility difficulties may arise from leiomyoma presence, although many women remain asymptomatic. Diagnosis can be made via ultrasound or magnetic resonance imaging, when precise mapping of the tissue is needed. Many treatment options are available ranging from surgical to medical and should be chosen depending on symptom severity, number and size of leiomyomas, patient age, fertility desires, and patient preferences. The objective of this article is to present a practical clinical perspective on uterine leiomyomas and an overview of contemporary treatment options.

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Laparoscopically assisted uterine fibroid cryoablation

Cited by 15 publications

References 30 publications

The Management of Uterine Leiomyomas

The Management of Uterine Leiomyomas

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

Etiology, Diagnosis, and Management of Uterine Leiomyomas

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