Vol 95, No 3 (2024)
Review paper
Published online: 2023-07-21

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Current status and outlook of minimally invasive treatment for leiomyomas

Bin Meng1, Ning Liu1, Xiaotao Wang1, Zhe Geng1, Qian Li1, Mingmin Xu1
Pubmed: 37548497
Ginekol Pol 2024;95(3):212-217.

Abstract

Objectives: Leiomyomas are benign, highly prevalent gynecologic conditions that can cause abnormal uterine bleeding, pelvic pain, urinary difficulties, and/or bladder or rectal obstruction. With advances in medical technology, women are increasingly interested in treatments that avoid surgery and/or preserve the uterus, which has undoubtedly contributed to the development of minimally invasive approaches. This article reviews the literature and evaluates the effectiveness and safety of minimally invasive approaches for the treatment of leiomyomas and describes the current state of development of minimally invasive treatment modalities for leiomyomas.

Material and methods: Web of Science and PubMed were systematically evaluated using the following keywords: uterine artery embolization, high-intensity focused ultrasound, microwave ablation, radiofrequency ablation, myomectomy, hysterectomy, leiomyomas, fertility. English abstracts relevant to the topic were selected and full-text articles were carefully analyzed.

Results: Uterine artery embolization is an effective treatment modality that has been widely validated, and the remaining means each have their distinct advantages in clinical practice, but more practical and comparative studies are needed. Minimally invasive myomectomy and minimally invasive hysterectomy are technically advanced compared to classical open surgery and are widely used due to the completion of practical experience, but a continuous interest in non-invasive minimally invasive treatment modalities is retained.

Conclusions: Minimally invasive treatment modalities for leiomyomas have emerged as an important treatment option when considering patient requirements, and further research and practice are needed to support their development into a mainstream modality for the treatment of leiomyomas.

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References

  1. Stewart EA, Laughlin-Tommaso SK, Catherino WH, et al. Uterine fibroids. Nat Rev Dis Primers. 2016; 2: 16043.
  2. Krzyzanowski J, Wozniak S, Szkodziak P, et al. Minimally invasive treatment options for uterine fibroids — state-of-the art 2021. Ginekol Pol. 2022; 93(3): 242–247.
  3. Noël-lamy M, Simons M, Mironov O, et al. Effectiveness of intra-arterial lidocaine for pain control after uterine artery embolization: a prospective randomized study. J Vasc Interv Radiol. 2016; 27(3): S17–S18.
  4. Resnick NJ, Kim E, Patel RS, et al. Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 2014; 25(3): 443–447.
  5. Manyonda I, Belli AM, Lumsden MA, et al. FEMME Collaborative Group. Uterine-Artery embolization or myomectomy for uterine fibroids. N Engl J Med. 2020; 383(5): 440–451.
  6. Coakley FV, Foster RF, Farsad K, et al. Pelvic applications of MR-guided high intensity focused ultrasound. Abdom Imaging. 2013; 38(5): 1120–1129.
  7. Trumm CG, Stahl R, Clevert DA, et al. Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients. Invest Radiol. 2013; 48(6): 359–365.
  8. Silberzweig JE, Powell DK, Matsumoto AH, et al. Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology. 2016; 280(3): 675–692.
  9. Gorny KR, Borah BJ, Brown DL, et al. Incidence of additional treatments in women treated with MR-guided focused US for symptomatic uterine fibroids: review of 138 patients with an average follow-up of 2.8 years. J Vasc Interv Radiol. 2014; 25(10): 1506–1512.
  10. Sridhar D, Kohi MP. Updates on mr-guided focused ultrasound for symptomatic uterine fibroids. Semin Intervent Radiol. 2018; 35(1): 17–22.
  11. Lee JS, Hong GY, Lee KH, et al. Safety and efficacy of ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroids and adenomyosis. Ultrasound Med Biol. 2019; 45(12): 3214–3221.
  12. Zou M, Chen L, Wu C, et al. Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound. BJOG. 2017; 124 Suppl 3: 30–35.
  13. Lee BB, Yu SP. Radiofrequency ablation of uterine fibroids: a review. Curr Obstet Gynecol Rep. 2016; 5(4): 318–324.
  14. Baxter BL, Seaman SJ, Arora C, et al. Radiofrequency ablation methods for uterine sparing fibroid treatment. Curr Opin Obstet Gynecol. 2022; 34(4): 262–269.
  15. Lin L, Ma H, Wang J, et al. Quality of life, adverse events, and reintervention outcomes after laparoscopic radiofrequency ablation for symptomatic uterine fibroids: a meta-analysis. J Minim Invasive Gynecol. 2019; 26(3): 409–416.
  16. Taheri M, Galo L, Potts C, et al. Nonresective treatments for uterine fibroids: a systematic review of uterine and fibroid volume reductions. Int J Hyperthermia. 2019; 36(1): 295–301.
  17. Polin M, Hur HC. Radiofrequency ablation of uterine fibroids and pregnancy outcomes: an updated review of the literature. J Minim Invasive Gynecol. 2021; 28(11): S23.
  18. Liu H, Zhang J, Han ZY, et al. Effectiveness of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids: a multicentre study in China. Int J Hyperthermia. 2016; 32(8): 876–880.
  19. Zhao WP, Han ZY, Zhang J, et al. A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids. Eur J Radiol. 2015; 84(3): 413–417.
  20. Jonsdottir G, Beermann M, Lundgren Cronsioe A, et al. Ultrasound guided microwave ablation compared to uterine artery embolization treatment for uterine fibroids - a randomized controlled trial. Int J Hyperthermia. 2022; 39(1): 341–347.
  21. Marín-Buck A, Karaman E, Amer-Cuenca JJ, et al. Minimally invasive myomectomy: an overview on the surgical approaches and a comparison with mini-laparotomy. J Invest Surg. 2021; 34(4): 443–450.
  22. Garneau AS, Lababidi SL, Akin JW. Comparison of operative outcomes for abdominal and laparoscopic myomectomies. Fertility and Sterility. 2018; 110(4): e397–e398.
  23. Lu B, Wang Q, Yan L, et al. Analysis of pregnancy outcomes after laparoscopic myomectomy: a retrospective cohort study. Comput Math Methods Med. 2022; 2022: 9685585.
  24. Liao P, Jiang J, Zeng YH, et al. Comparison of outcomes of hysteroscopic myomectomy of type 2 submucous fibroids greater than 4 cm in diameter via pretreatment with HIFU or GnRH-a. Int J Hyperthermia. 2021; 38(1): 183–188.
  25. Piecak K, Milart P. Hysteroscopic myomectomy. Menopausal Rev. 2017; 16(4): 126–128.
  26. Ciebiera M, Łoziński T, Wojtyła C, et al. Complications in modern hysteroscopic myomectomy. Ginekol Pol. 2018; 89(7): 398–404.
  27. Baxi RP, MacKoul PJ, Danilyants N, et al. A value-based approach to hysterectomy: comparison of minimally invasive hysterectomy techniques. J Minim Invasive Gynecol. 2017; 24(7): S147–S148.
  28. Luchristt D, Brown O, Kenton K, et al. Modern trends in operative time and outcomes in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2020; 27(7): S1.
  29. Wallace K, Zhang S, Thomas L, et al. Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids. Fertil Steril. 2020; 113(3): 618–626.