Artery Embolization Presents Many Dangers:
Laparoscopic Myomectomy or Hysteroscopy Are Superior Solutions
For Fibroid Tumors
GA--At age 32 Atlanta businesswoman Anne J. was told by doctors that
she would never have a baby--or that if she ever did, it would be a
miracle. In fact, she had been told since she was 24 that she
should have a hysterectomy to treat benign fibroid tumors.
Wisely, Anne continued to search for other options, and ten years
later she and her husband are thrilled with their son born in June
1995 after she opted for a treatment that left her uterus and
Her laparoscopic myomectomy was performed by Thomas L. Lyons, M.D.,
of the Center for Women's Care & Reproductive Surgery in Atlanta. A
surgical pioneer, he has received numerous awards for his
breakthroughs in gynecologic surgery since 1980. In 1990 he authored
the LSH procedure, or Laparoscopic Supracervical Hysterectomy, which
leaves the cervix intact to help prevent pelvic prolapse and improve
sexual function post-surgery. He also developed the Laparoscopic
Burch procedure for stress urinary incontinence.
The minimally invasive myomectomy to remove Anne's fibroid tumors
was done through a trocar, a small tubular instrument inserted into
her abdomen. Because the incisions were so tiny, she recuperated
from the procedure in approximately two weeks. Within months she
"In the past, when myomectomy was performed as 'open' surgery, there
was significant downtime for the patient and no guarantee of
pregnancy. There aren't any strict guarantees today, but the
laparoscopic approach decreases the chances of problems in
recovery," said Dr. Lyons.
The Option Not Taken
A decade ago, Uterine Artery Embolization (UAE) was still under
development, and would not have been an appropriate choice for Anne
since she wanted to preserve her fertility. However, today many
women are opting for that treatment without a full understanding of
some of its potential side effects.
Uterine artery embolization is a treatment for fibroids that was
originally performed in France and first reported in the medical
literature in 1995. With embolization, a physician injects small
particles through a catheter placed in the uterine artery. The
particles block the blood supply to the fibroids, resulting in the
death of the fibroid tissue. This leads to shrinkage of the fibroids
and relief of symptoms for most patients, without the need for
surgery or removal of the uterus.
Direct marketing of UAE to patients by hospitals and radiologists
leaves out some important points: the amount of pain involved with
the procedure both during and afterwards and the degree of serious
complications associated with the procedure.
Complications include death from embolism or septicemia (pus-forming
or other pathogenic toxins) resulting in organ failure; infection;
and microspheres or PVA (polyvinyl alcohol) particles flowing into
organs where they were not intended to go, causing damage.
Additionally, loss of ovarian function has been reported, along with
infertility, loss of orgasm, menopause, formation of scar tissue,
and foul vaginal odor due to decaying fibroid tissue remaining
inside the uterus.
In addition, after UAE, fibroids have been known to grow back.
"Patients need to research all their options before embarking upon
any medical or surgical procedure," said Dr. Lyons. He also offers
other in-office solutions for fibroids when appropriate for the
If the fibroids are inside the uterus, just below the lining and
projecting into the uterine cavity, hysteroscopic removal may be a
good solution. With hysteroscopy, a fiber-optic scope is advanced
into the uterus through the vagina and cervix. It is commonly used
in conjunction with a dilation and curettage (D and C) to diagnose
Polyps or submucosal fibroids may also be removed using
hysteroscopy. Larger submucosal fibroids can sometimes be removed or
partially removed with a hysteroscopic device that shaves off pieces
of tissue. These methods may be combined with techniques to ablate
or remove the lining of the uterus to control bleeding. Endometrial
ablation is the intentional destruction of the uterine lining and is
intended to permanently stop menstrual bleeding. If successful, it
may prevent future pregnancy.
Depending upon age and training, not all physicians are familiar
with, or able to perform some of the newer procedures. Dr. Lyons
has trained physicians worldwide on the laparoscopic procedures he
has developed. He is in demand to perform telesurgeries, speak and
lead global symposia on the latest techniques in laparoscopic
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