Understanding hysteroscopic myomectomy to remove uterine fibroids. Read more
Uterine fibroids are noncancerous tumors that originate from the muscle layer of the uterus. They are the most common tumor of the uterus and occur in up to 70% of women, however vary in incidence depending on ethnicity and family history. Uterine fibroids (also called leiomyomas) can range from a small pea size to even the size of a grapefruit or softball! As you can imagine, the larger a fibroid becomes the more problematic it can be, with pelvic pain and heavy and irregular bleeding being the most common symptoms women experience.
In the past, fibroids have been treated in various ways. Birth control pills, progesterone injections, and intrauterine devices (IUDs) have all been tried, but often with only modest success. Most often fibroids require surgery in the form of either a myomectomy or a hysterectomy. A myomectomy is the surgical removal of fibroids from the uterus. Unfortunately, even after removing them, new fibroids can still grow back. Hysterectomy is the most definitive form of surgery for fibroids, however this involves removing the entire uterus. While this surgery will eliminate any chance of fibroids returning, women often require large incisions (especially when the fibroids are large), lose their ability to have children, and also require a lengthy recovery time of up to six to eight weeks.
The good news is that a new technique called Acessa has been developed as a more minimally invasive way to treat uterine fibroids. It involves tiny incisions, good success rates, and short recovery times, all while preserving the uterus and without having to remove any native tissue or organs. Acessa is performed laparoscopically and uses radiofrequency ablation through a probe tip that is inserted through the belly and directly into the fibroid using ultrasound guidance. Once the tip is inserted into a fibroid, tiny microarrays are deployed directly into the tissue and heat is applied to destroy the fibroid from within. This procedure is performed on as many fibroids as are found by the ultrasound probe. Acessa is performed in a hospital or ambulatory surgical center under general anesthesia and usually takes around 1-2 hours. Patients are discharged the same day and typical recovery time is only around 3-7 days!
The success rates of the Acessa procedure are excellent. Clinical studies have shown that the vast majority of patients experience a significant reduction in their bothersome symptoms and an improvement in their quality of life. In fact, in recent surveys, 98% of patients have reported overall satisfaction with the procedure and would recommend it to a friend.
If you think that you may have uterine fibroids because you suffer from either heavy or irregular periods, anemia, or pelvic pain, we encourage you to discuss this with your doctor at MacArthur OBGYN. Myomectomy or hysterectomy may still be good options for you. However, we are now performing Acessa, a new minimally invasive way to treat your fibroids with small incisions, shorter recovery times, and preserving the uterus all at the same time!
Dr. Andrea Arguello discusses a new procedure called Acessa for minimally invasive treatment of uterine fibroids. This procedure helps eliminate fibroid related symptoms without having to have a hysterectomy.
What is Symphion?
It is a hysteroscopic (very small camera/telescope that goes into the uterus) tool used to remove fibroids and/or polyps without having to cut or remove any part of the uterus. Also, it’s an outpatient procedure, so you can go home the same day.
So, what are fibroids?
These are very common non-cancerous tissue growths in the uterus. The size and number of these fibroids is variable… can be a single fibroid or multiple fibroids, and can range from very small to the size of a cantaloupe. They can be found on a stalk inside or outside the uterus. They can also be found in any layer of the uterus: in the muscle wall (intramural), under the outer layer (subserosal), or just below the inner lining of the uterus (submucosal).
So, what are polyps?
These are small protrusions of the uterine lining (endometrium) that grow, become fragile, and start to bleed. Here is a picture of two polyps and the Symphion device.
So, are polypectomies and myomectomies safe? Effective?
With a hysteroscopic approach or with Symphion, the complication rate is less than 1%. The procedure is 90% effective in reducing heavy bleeding and recurrence rates at 2 years are less than 10% for fibroids and less than 3% for polyps.
What are the steps of the procedure?
- Your doctor will gently open your cervix and insert a very slender camera into your uterus.
- After visualizing the polyp or fibroid, a slender wand-like device is passed through the camera/telescope into your uterus. This wand suctions and cuts the fibroid or polyp into very small pieces and removes the tissue.
- Once the polyp/fibroid is completely removed, the wand and camera are removed. Nothing is left in your body after the procedure.
What’s the recovery like and what can I expect after the Symphion procedure?
Some women have mild cramping, for which most only need over the counter pain medicine. Most women are back to normal activities within a day or two. You are unlikely to have any complications, but call your doctor immediately if you have any of the following:
- Fever > 100.4°F
- Increasing pain not relieved by pain meds
- Nausea, vomiting, dizziness, shortness of breath
- Bowel or bladder problems
- Greenish vaginal discharge
When will I know how well the procedure worked?
This varies for every woman, but plan to give your body approximately 3 months to fully heal. By then you and your doctor should be able to tell what your cycles are going to be like.
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