ABSTRACT
Uterine fibroids are the most common benign tumor of the uterus in women of reproductive
age. However, most of them are asymptomatic and do not require any treatment. Menorrhagia
and pelvic pain are the most usual symptoms, and some women may present with infertility
or pregnancy-related complications. In those with abnormal uterine bleeding, one should
exclude other causes of abnormal vaginal bleeding including endometrial cancer. Diagnosis
of uterine fibroid is established by pelvic ultrasonography with or without saline
infusion hysterosonography. Management options depend on the patient's fertility potential
and desire for future pregnancy. Submucous myoma should be treated by a hysteroscopic
approach. Intramural and subserous myomas in women who opt for nonsurgical treatment
could be treated with uterine artery embolization (UAE), high-intensity focused ultrasound
(HIFU), or medical treatment such as selective gonadotropin-releasing hormone agonists,
progesterone receptor modulators, or aromatase inhibitors. All interventions aside
from hysterectomy provide temporary relief, although myomectomy, UAE, and HIFU provides
more durable symptom relief relative to current medical management. Patients wishing
to preserve their fertility are best treated by myomectomy, which can be done by laparoscopy.
A laparoscopic approach is more advantageous than laparotomy, but laparoscopic suturing
is more demanding. This can be overcome by robotic-assisted laparoscopic myomectomy.
KEYWORDS
Laparoscopy - laparoscopic myomectomy - hysteroscopy - hysteroscopic myomectomy -
robotic-assisted myomectomy
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Togas TulandiM.D. M.H.C.M.
687 Pine Ave. West, Montreal, Quebec
Canada, H3A 1A1
Email: togas.tulandi@mcgill.ca
