Minimally Invasive Approaches to the Surgical Management of Fibroids

Abstract

Uterine fibroids, as the most common benign neoplasm of the female reproductive tract, can significantly impact a woman's quality of life through abnormal uterine bleeding, infertility, and bulk symptoms. When medical therapy for symptomatic fibroids fails, surgery is the recommended treatment. While a hysterectomy through laparotomy was historically the first-line surgical approach for fibroids, multiple minimally invasive and uterine-sparing techniques are now available. An evidence-based literature review of the following minimally invasive approaches is detailed in this article: hysteroscopic myomectomy, laparoscopic and robotically assisted myomectomy, laparoscopic and robotically assisted hysterectomy, and ultrasound-guided radiofrequency ablation. For each approach, this review discusses the indications, patient selection, adjunct preoperative treatment modalities, instrumentation, techniques, and pertinent intraoperative considerations such as fluid management, interventions to reduce blood loss, antiadhesion barriers, and tissue extraction. Perioperative benefits, long-term outcomes including recurrence and fertility, and comparisons of outcomes among the various approaches are outlined as well. With continued technological advancements and surgical innovations, minimally invasive techniques will become the mainstay of surgical management for symptomatic fibroids to provide high-quality patient-centered care.

Vitamin D and Uterine Fibroids—Review of the Literature and Novel Concepts

“…Clinically symptomatic UFs are most often treated with surgery [ 2 , 22 ]. Various types of surgical methods are available, both open and endoscopic (hysterectomies, myomectomies, hysteroscopic resections) [ 22 , 23 ]. UFs are the leading reason for the hysterectomy [ 21 , 24 ].…”

“…The optimal treatment should reduce blood loss and tumor burden, while preserving fertility [ 25 ]. Women who wish to retain their uterus can be offered with less invasive methods [ 22 , 23 , 26 ]. Nevertheless, many of them will require a re-intervention in the future [ 27 ].…”