Medical Help for Fibroids

Advanced Laparoscopic Surgery vs. Uterine Artery Embolization and Open Hysterectomy

	Advanced Laparoscopic Surgery	Uterine Artery Embolization	Open Hysterectomy
Discharge Home	24 hours or less, 90% discharged home day of surgery	Overnight admisstion for all patients due to pain	2 to 4 days
Recovery Time	5 to 7 days, up to 2 weeks	Days to weeks, depending on pain level	6 to 8 weeks
Incision Size	2 – ¼ inch for most patients up to 3 – ¼ inch and 1 – 1 to 2 inch for very large fibroids	2 – ¼ inch for catheter	6 to 12 inches
Pain Tolerance	Excellent to good, first 1 to 2 days mild to moderate only. Morphine pump not needed – pain controlled with motrin and percocet only.	Can range from excellent to poor with long term pain due to necrosis (death) of fibroids. All patients admitted after procedure for pain control with morphine pump	Poor due to large incision
Regrowth of Fibroids	None	Recurrence rates of 20 – 40+%, depending on size of uterus and fibroids	None
Symptomatic Relief Long Term	Excellent – fibroids cannot recur – uterus is removed	Fibroids can regrow leading to recurrence of bleeding, pain, pressure	Excellent – fibroids cannot recur – uterus is removed
Fibroid Size	Unlimited	Limited – single fibroids greater than 7 cm, pedunculated fibroids (on stalks), submucosal fibroids (in cavity), or larger uteri with less effective results	Unlimited
Blood Control	Very Good to Excellent	Excellent	Good
Procedure Time	30 minutes to 1.5 hours	1 hour in radiology suite	1 to 2 hours

What is myomectomy?

Myomectomy refers to removing only the fibroids and leaving the uterus and ovaries intact. This procedure is indicated for those patients who wish to preserve fertility, or for those that simply want to preserve the uterus. Laparoscopic Assisted Abdominal Myomectomy (LAAM), developed by the Women’s Surgery Center, is the procedure of choice. LAAM can be used for fibroid removal for any size uterus. This procedure is minimally invasive, and is the best option for those patients who want to preserve the uterus so they may become pregnant. Abdominal myomectomy – a procedure requiring a large incision – has no advantages over LAAM. Abdominal myomectomy usually results in increased blood loss, pain, prolonged hospital stay, and long recovery of 6 to 8 weeks. Note that uterine artery embolization should not be used for treatment of fibroids if pregnancy is desired. Recent studies have indicated that embolization procedures can cause infertility due to decreased blood flow to the uterus, thereby affecting implantation of the embryo into the uterine lining. LAAM allows patients to be discharged home from the hospital the day after surgery, and uses very small incisions. The procedure is extremely safe, with minimal blood loss and fast recovery of less than 2 weeks. LAAM has almost eliminated the need to perform necessary hysterectomy at the time of myomectomy (due to excessive bleeding) when using techniques developed at the Women’s Surgery Center. It is important to understand that myomectomy is not indicated in all patients. Those patients who do not want to become pregnant and have a massively enlarged fibroid uterus should consider hysterectomy as the best option. Myomectomy will not prevent recurrence of fibroids, but will remove those fibroids present in the uterus at the time of surgery.

Comparison Chart of Myomectomy Treatment Options

	LAAM-BUAL	Laparoscopic Myomectomy	Open Myomectomy
Discharge Home	24 hours or less	24 hours or less	2 to 4 days
Recovery Time	2 weeks or less	2 weeks or less	6 to 8 weeks
Incision Size	3 - ¼ inch 1 – 1.5 to 2 inch	3 – ¼ inch 1 - 1 inch	1 – 6 to 8 inch
Pain Tolerance	Very Good	Excellent	Poor
Fibroid Size	Unlimited – fibroids of all size, all locations, all depths	Very limited – small to moderate only, external fibroids	Unlimited – all sizes, depths, locations
Blood Control	Excellent	Fair	Fair to Good
Muscle Closure	Excellent	Fair to Poor	Excellent
Procedure Time	60 - 90 minutes	1 to 3 hours or more	2 hours of less

Source: http://www.womenssurgerycenter.com/treatment/fibroids/