Semin Reprod Med 2017; 35(06): 533-548
DOI: 10.1055/s-0037-1606304
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Minimally Invasive Approaches to the Surgical Management of Fibroids

Harold Y. Wu
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Karen C. Wang
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
03 November 2017 (online)

Abstract

Uterine fibroids, as the most common benign neoplasm of the female reproductive tract, can significantly impact a woman's quality of life through abnormal uterine bleeding, infertility, and bulk symptoms. When medical therapy for symptomatic fibroids fails, surgery is the recommended treatment. While a hysterectomy through laparotomy was historically the first-line surgical approach for fibroids, multiple minimally invasive and uterine-sparing techniques are now available. An evidence-based literature review of the following minimally invasive approaches is detailed in this article: hysteroscopic myomectomy, laparoscopic and robotically assisted myomectomy, laparoscopic and robotically assisted hysterectomy, and ultrasound-guided radiofrequency ablation. For each approach, this review discusses the indications, patient selection, adjunct preoperative treatment modalities, instrumentation, techniques, and pertinent intraoperative considerations such as fluid management, interventions to reduce blood loss, antiadhesion barriers, and tissue extraction. Perioperative benefits, long-term outcomes including recurrence and fertility, and comparisons of outcomes among the various approaches are outlined as well. With continued technological advancements and surgical innovations, minimally invasive techniques will become the mainstay of surgical management for symptomatic fibroids to provide high-quality patient-centered care.

Funding

There was no specific source of funding for this review article.