Surgical Rx

SURGICAL TECHNIQUES

Key Points

Surgical therapy for leiomyomas can be categorized into procedures that maintain or enhance fertility, and those that remove the option for future pregnancy.
Both endometrial ablation and hysterectomy are reserved for patients with leiomyoma symptoms who wish no future fertility and who fail, are intolerant of, or otherwise don't wish medical therapy.
Myomectomy is the longest standing and most evaluated intervention for women with infertility or those who wish to retain their ability to carry a pregnancy. It can be performed via vaginal, hysteroscopic, or abdominal routes, the latter either laparoscopically or laparotomically.
Even for those women who do not desire future fertility, myomectomy by the least invasive route should remain an option.
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Surgical Principles

Traditional surgical techniques for the treatment of leiomyomas generally rely upon "extirpation" or the removal of tissue. Targeted removal of leiomyomas is called myomectomy while uterine extirpation is termed hysterectomy, a procedure that can be performed vaginally or by an abdominal route, either laparoscopically or via laparotomy (laparotomies). Supracervical or subtotal hysterectomy refers to removal of only the uterine corpus, leaving the uterine cervix, in situ. In selected instances, removal or ablation of the endometrium - "Endometrial Ablation" or EA - can be effective in selected patients for abnormal uterine bleeding symptoms.

Endometrial Ablation