Although a myomectomy can preserve a patient’s fertility potential, women should know that future pregnancy is not a guarantee, and, if successful, childbirth will often require a C-section. “Even though we take the fibroids out and repair the uterine muscle, that muscle integrity is forever changed, so, depending on the extent of the myomectomy, you don’t want to stress it with labor at term,” Dr. Advincula says.
Now, a new approach to fibroid removal, called transcervical radiofrequency ablation, may increase the likelihood of avoiding a C-section, and is available at NewYork-Presbyterian. It uses a miniaturized ultrasound probe to destroy fibroids from inside the uterus with high-energy waves. This outpatient, incision-free method also allows doctors to remove fibroids in hard-to-reach places and has an easier recovery — just a day or two with minimal to no pain. “We don’t make any big incisions on the uterus so it doesn’t automatically commit women to having a C-section when they have a baby in the future,” Dr. Advincula says. The procedure typically takes only two to three minutes to treat each fibroid, he says. “It’s very fast.”
“It is one of the newest minimally invasive surgical treatment options available, and we’re the first major academic medical center in the tri-state area to acquire and adopt it as an option for patients,” Dr. Advincula says. Although pregnancy data is still being collected and established, he says, “It is an extremely promising treatment that exclusively targets the fibroid and not only preserves a woman’s uterus but keeps the surrounding muscle intact.”
The ideal candidate is someone who has a small number of fibroids that are all less than 5 centimeters in diameter and are close to the endometrial cavity. “There’s a subset of patients that fit that profile,” says Dr. Advincula. “It gives them another option, where they would otherwise end up with a potentially more invasive procedure. And it not only preserves potential fertility, but may give them the option of going through vaginal childbirth in the future, barring any pregnancy-related reasons for undergoing a C-section.”
If fertility is not an issue, women can opt for uterine fibroid embolization, in which particles are delivered through a catheter inserted in the groin or wrist and guided into the blood vessels that feed fibroids to cut off their blood supply and cause them to shrink. With hysterectomy, the entire uterus, including fibroids, is removed.
“There’s a role for every therapeutic,” Dr. Advincula says. “But the right choice depends on the patient’s clinical profile and future desires.”
Dr. Arnold Advincula is a paid consultant to AbbVie, the maker of elagolix.