Surgery is the most effective way of treating uterine fibroids. Fibroids which indent the cavity of the uterus (intracavity fibroids and submucus fibroids), are usually amenable to transcervical resection using the operating hysteroscope. Some fibroids in the wall of the uterus or on the surface of the uterus are amenable to laparoscopic surgery, but for women with multiple fibroids and/or large fibroids, open surgery is preferable. The surgical technique I use for laparoscopic myomectomy and myomectomy via laparotomy is to remove the fibroids using the harmonic scalpel. To minimise blood loss at the time of surgery I recommend medical pre-treatment with a 3-month course of gonadatrophin releasing hormone analogue injections and intraoperatively I inject Pitressin into the uterus. I take great care to identify the cavity of the uterus using a small catheter inside the cavity of the uterus, through which I inject blue dye. After removing the fibroids I close the myomectomy cavity in layers and take great care with tissue handling to minimise any possibility of post-operative adhesion formation. Further precautionary measures I take are to either instill Adept fluid at the end of the operation, or apply Interceed to the suture lines. I have found both these techniques to be highly effective.
Some of the women I see have extremely large fibroids and many have been recommended to undergo hysterectomy. In most instances I find that it is possible to remove the fibroids without carrying out a hysterectomy operation. I also see women who have previously undergone myomectomy surgery in the past who now have a recurrence of fibroid growth. These repeat myomectomy operations can be complex, but with the techniques I employ I am almost always able to remove all the fibroids without needing to resort to hysterectomy.
The surgical treatment of fibroids often comes up for discussion with the Society for Reproductive Surgeons, of which I am a member.