52.4.

80

Drugs

Endometrial ablation

Myolysis

Myomectomy

1. Hysteroscopic myomectomy

2. Open myomectomy

3. Laparoscopic or Robotic myomectomy

Hysterectomy

Uterine Artery Embolization (UAE) Embolization is a technique that blocks the blood flow to the fibroid or fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.
UAE is performed in a radiology suite rather than an operating room, by an interventional radiologist. An intravenous (IV) line will be placed before beginning the procedure, and patient will be sedated. Patients will remain awake, but sleepy, throughout the procedure. A needle is placed in an artery in patients leg, at the groin crease. A small catheter is then placed into the artery and X-rays are taken of the arteries a test called an arteriogram that supply the fibroids. The catheter is then used to select these arteries and slowly inject particles called polyvinyl alcohol, which are the size of a sand grain. The particles block the flow of blood. After the left and right uterine arteries are embolized, another arteriogram is performed to confirm the procedure is complete. Afterward, patient must rest in bed for six hours, lying flat with your leg straight. The amount of pain patients experience varies. The most significant pain usually occurs immediately following the procedure and over the next six hours. Patients usually stay overnight in the hospital, so the doctors can monitor the arterial access site and provide adequate pain control. Patient will be discharged the next morning. Most women can return to full activity in a week. When blood flow to the fibroid is blocked, the fibroid gets no oxygen and will begin to die. This process happens over days to months. During this time the fibroid shrinks by about 40 to 50 percent and the uterus by about 30 to 40 percent.

Uterine Artery Embolization (UAE)

MR guided Focused Ultrasound Surgery MR guided Focused Ultrasound Surgery is a non-invasive, outpatient procedure which uses high doses of focused ultrasound waves (HIFU) to destroy uterine fibroids, without affecting any of the other tissues around the fibroid. The procedure is conducted in a magnetic resonance imaging (MRI) scanner which helps the physician "see" inside the body to pinpoint, guide, and continuously monitor the treatment.
Imagine using a magnifying glass to focus the sun's energy on a single point to create a flame to burn a leaf. The focused ultrasound energy is directed at a small volume of the fibroid, raising its temperature high enough to cause thermal ablation (killing of the cells) without impacting other tissues. Pulses of energy are repeated until the entire volume is treated.

During the procedure patient lie on stomach on a patient table that fits into a standard MRI scanner. First, the doctor identifies the fibroid(s) on MR images taken of the pelvic region. Then, after detailed planning, high energy focused ultrasound waves heat a small spot in the uterine fibroid to a temperature of up to 85oC. During the pulse or sonication, which lasts about 15 seconds, the doctor monitors the progress and reviews temperature-sensitive images. Since each sonication treats a very small volume, this process will be repeated until the required volume is treated, typically about 50 times. The procedure lasts about 3 hours depending upon the size and number of fibroids treated. Following the treatment the body gradually removes the treated tissue over a period of months, providing symptom relief.

MR guided Focused Ultrasound Surgery

REFERENCES
http://www.babycenter.com.my/preconception/suspectingaproblem/fibroids/ http://www.ucsfhealth.org/conditions/fibroids/treatment.html http://www.uterine-fibroids.org/mr_guided.html http://www.direct-healthcare.com/hysterectomy.htm http://www.umm.edu/patiented/articles/what_radical_surgery_hysterectomy_endometriosis_000074_11.htm http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW023212 http://www.fibroid.com/myomectomy