Surgical treatment of fibroids in heavy menstrual bleeding

Abstract

Uterine fibroids can cause abnormal uterine bleeding and their removal is beneficial in the treatment of heavy menstrual bleeding associated with fibroids for women who would like to preserve their uterus and fertility. Endoscopic (hysteroscopic and laparoscopic) approaches are the preferred methods of fibroid removal when appropriate. In the presence of submucosal fibroids, hysteroscopic resection is a simple, safe and effective treatment for heavy menstrual bleeding and reduces the need for more major surgery, such as hysterectomy. When abdominal myomectomy is required, laparoscopic myomectomy is the preferred choice in selected cases due to its advantages over open myomectomy.

Keywords: abdominal myomectomy; fibroids; hysteroscopic morcellator; hysteroscopic myomectomy; laparoscopic myomectomy; leiomyoma; morcellator; myomectomy; open myomectomy; resectoscope.

Figure 1.

A type 2 anterior wall fibroid measuring 2.5 cm is seen, ∼1/3 of the fibroid is intracavitary.

Figure 2.

The fibroid seen in Figure 1 has been completely resected, including its intramural portion.

Figure 3.

An enlarged uterus due to a large deep intramural fibroid in the left posterolateral wall. An additional small subserosal posterior wall fibroid is also visible.

Figure 4.

Diluted vasopressin is injected into the left broad ligament. A small pedunculated anterior wall fibroid is also visible.

Figure 5.

A posterior wall transverse incision is made over the fibroid to expose the fibroid and the plane between the fibroid and myometrium.

Figure 6.

Intramural fibroid after enucleation.

Figure 7.

Closed serosal incision using barbed suture.

Figure 8.

The incision is covered with a barrier antiadhesion agent.