Fibroids are benign tumors which grow beneath the outer layer of the uterus (subserosal), inside the muscular wall of the uterus (intramural), or inside the uterine cavity (submucus).
The etiology of fibroid formation is unknown, but there are indications that high estrogen levels and genetic predisposition might play a significant role.
Fibroids are responsible for infertility only in 2-3% of patients. Still, their size and location may prevent pregnancy, due to anatomic and functional uterine changes.
- Large intramural fibroids distort the anatomy and the endometrium, thus preventing embryo implantation.
- Large subserous fibroids distort the fallopian tubes and prevent sperm from reaching the ovum.
- Large submucus fibroids prevent normal implantation and cause abnormal uterine bleeding.
Fibroids may also cause abortion and premature labor.
How fibroids are diagnosed
Apart from clinical examination, diagnosis can be made by using one of the following tests.
- Ultrasound Testing
This method uses high frequency sound waves to detect fibroids inside and around the body of the uterus and cervix.
- Hysterosalpingogram (HSG)
This method uses x-rays and a special dye to detect fibroids on the inside of the uterus and see if the fallopian tubes are patent.
This method uses a small fiberoptic telescope inserted inside the uterine cavity to look for fibroids and at the same time remove them.
This method uses a small fiberoptic telescope inserted, through an incision near the navel, inside the abdominal cavity, to look for and remove fibroids.
What treatment options are available
Treatment is mainly surgical, either by laparotomy (traditional approach) or laparoscopy, depending on surgical skills.
Laparoscopic myomectomy is a difficult procedure requiring advanced laparoscopic skills. The technical difficulty of this procedure lies not only to the removal but also to the adequate suturing of the uterus in order to avoid , future uterine rupture. After a small incision is made near the navel, the operation is performed through a small fiberoptic telescope inserted inside the abdominal cavity. Compared to laparotomy, tissue trauma and blood loss are minimal, recovery is short and postoperative complications (e.g postoperative pelvic and abdominal adhesions which compromise fertility ) are reduced.
Today 98-99% of all operations are being carried out by operative laparoscopy.
Watch Dr. Vasilis Kapetanakis Unique Technique of removing fibroids laparoscopically avoiding eleectrical morcellation.