Myolysis of Uterine Fibroids: Is There a Role?

Abstract

Myolysis is among the new procedures under development for the treatment of symptoms related to uterine leiomyoma. The procedure targets the destruction of fibroids using one of a number of focused energy delivery systems including those based upon radiofrequency electricity, supercooled cryoprobes, and, most recently, focused ultrasound monitored by real time magnetic resonance imaging. For thermomyolysis and cryomyolysis, delivery of the energy requires access to the tissue by laparoscopy, and, in some instances, hysteroscopy. For focused ultrasound, the patient is detached from the energy source, which is delivered by an array of external beams. Clinical evaluation has been confined to case series, but it is evident that the approach results in a variable degree of reduction of the total uterine mass, and, usually, a reduction in uterine bleeding. Clearly, longer term appropriately designed comparative trials are required that evaluate and compare myolysis with myomectomy, uterine artery embolization, and hysterectomy, to name a few.

Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids

“…Fibroid ablation using either ultrasonography or magnetic resonance guided focused ultrasound minimizes the damage to surrounding tissue by focusing on the area within the fibroid; however, cases of skin burns and bowel perforation have been reported (Zupi et al, 2006;Chodankar and Allison, 2018). It is mostly limited to centrally situated fibroids, whereas fibroids usually grow peripherally.…”

The uterus and fertility

“…Myolysis refers to the technique where an attempt is made to disrupt or abolish the blood supply to the myoma and cause shrinkage using radiofrequency electricity, supercooled cryoprobes, or focused ultrasound (136). At present, the procedure is rarely performed, and is not recommended for women who wish to get pregnant, because there is a significant risk of uterine rupture (137,138).…”

Uterine Leiomyomas: Safety and Efficacy of US-guided Suprapubic Transvaginal Radiofrequency Ablation at 1-year Follow-up

“…Currently, there are a large variety of less invasive alternatives to the traditional surgical approach of laparotomy with hysterectomy or myomectomy that can be used to treat uterine leiomyomas. These include laparoscopic myomectomy with in situ morcellation of the leiomyoma (6,7), uterine artery embolization (8)(9)(10), and thermal ablation techniques with use of temperature to destroy tissue, including highintensity focused ultrasound (11)(12)(13), thermal ablation myolysis (14-16), cryomyolysis (17)(18)(19), and laparoscopic-guided laser ablation (20,21). Laparoscopic myomectomy with in situ morcellation of the uterine leiomyoma can be performed to preserve the uterus; however, it involves several difficulties, such as myometrial wound hemorrhage, enucleation and morcellation of the leiomyomas, suturing of the uterine wound, and possible injury to surrounding organs (6,7).…”