Uterine Fibroids
Non-cancerous tumors that can grow inside or outside of the uterus, fibroids are very common in women and often cause no symptoms. Such cases are left alone and not treated, said Dr. Obianwu. "They are more common in African-American women but generally may affect up to 30 to 40 percent of all women."
"The key to treatment is whether there are symptoms, because we know that when women go through menopause and estrogen levels decrease, these fibroids tend to shrink, so one option is just observation."
Fibroids can be of any size and can cause a host of symptoms and Dr. Obianwu notes that other pelvic conditions often can mimic each other, so a gynecological exam and evaluation is advised. The symptoms can include:
- Infertility;
- Pelvic pain or pressure;
- Abdominal enlargement;
- Heavy and prolonged bleeding;
- Pain during intercourse;
- Pressure on the bowel or bladder which disrupts elimination, and \
- Pain in the lower back.
"Surgery usually is the last resort and I try to detail for women the various options," said Dr. Obianwu. "We try nonsurgical and less invasive options and other treatments such as medications and injections, depending on the patient condition," said Dr. Obianwu.
"One less invasive treatment is uterine fibroid embolization (UFE). UFE is an outpatient procedure in which we use a catheter inserted into a blood vessel in the groin to enter the uterine blood vessels and inject a gel foam that plugs the vessels to occlude the blood supply to the fibroid so it shrinks over time."
This procedure usually is not recommended for women who seek future pregnancies because there is a lack of good studies looking at the effects of decrease in the blood supply to the womb, he said.
Most conservative, non-surgical treatments are successful in achieving relief from fibroids in 60 to 80 percent of the cases, but in about 20- 40 percent of those cases a second procedure will follow, said Dr. Obianwu. He said that in one case the fibroid of the patient was so large she had difficulty breathing or even sitting in her office chair. Embolization would not have been a viable option, he said.
"In most patients we try conservative treatments to palliate and treat their symptoms until they go through menopause and if we can do that then we may not need to resort to hysterectomy options."
But hysterectomy has been a major final answer for many. Of the 600,000 hysterectomies done annually in the U.S., some 40-to50 percent are prompted by or related to symptoms caused by fibroids, he estimated.
"Fibroids are not on the rise, but what has changed is what we can offer women -- minimally invasive surgery options instead of a hysterectomy and open surgery," said the physician. "Now, with minimally invasive techniques and robotic-assisted techniques, we have better outcomes."
In years past, the removal of just the fibroid - myomectomy - used to be accomplished with open surgery, marked by substantial blood loss and pain and requiring three or four days in the hospital and four-to-eight weeks of recovery.
"I perform 80-to-90 percent of myomectomies laparoscopically, and most of my patients go home the same day," he said. "The big change has been robotics. I can remove fibroids of up to 20-24cm in size (the size of a 5 month pregnant belly) and my patients go home within the same day. Fibroids can occupy the womb, take up space, block the Fallopian tubes and cause infertility and premature labor."
"In the past, women with previous multiple abdominal and pelvic surgeries with a lot of scar tissue or obese women might not have been candidates for laparoscopic surgery and could require open surgery. Now I can approach such surgery with more confidence robotically because of the better visualization, the 3-D image and precision that is better than with conventional laparoscopy."
Women whose fibroids are causing infertility also can benefit from the better imaging and precision of the robotic surgery. In many cases multiple fibroids may be blocking the Fallopian tubes and preventing conception, said the surgeon. Robotic surgery puts the organ in question directly in front of the surgeon via a high-definition screen, and the improved image and dexterity of the robotic assistance allows the surgeon to operate with better accuracy.
