Minimally invasive procedures preferred to hysterectomy for uterine fibroids

Minimally invasive procedures preferred to hysterectomy for uterine fibroids | Image Credit: © shidlovski - © shidlovski - stock.adobe.com.

Minimally invasive procedures are preferable for managing uterine fibroids compared to hysterectomy, according to a recent study from Mayo Clinic researchers published in The New England Journal of Medicine.¹

Approximately 80% of women are impacted by uterine fibroids within their lifetime, with approximately half of uterine fibroid patients experiencing significant adverse impacts on quality of life and fertility. These include severe pain and anemia and are a significant driver toward removal of the uterus through hysterectomy.

There are multiple risks associated with removal of the uterus, such as higher odds of depression, anxiety, cardiovascular disease, and mortality. These risks are higher in patients with their uterus removed at an earlier age.

According to Shannon Laughlin-Tommaso, MD, Mayo Clinic ob-gyn and co-lead author of the paper, there are less invasive options available to many women with uterine fibroids. These patients deserve to receive counseling about the risks of hysterectomy so they may consider these less invasive procedures.

“Less invasive treatments can help women recover faster and resume their normal activities more quickly,” said Laughlin-Tommaso. “Additionally, many studies have shown that there are health benefits to keeping the uterus and ovaries.”

The Mayo Clinic study reported a lack of attempting less invasive options first in 60% of women undergoing hysterectomy. Methods that may prove effective without the need for hysterectomy include medical therapies, hormone-releasing intrauterine device, radiofrequency ablation, focused ultrasound ablation, and uterine artery embolization.

Mayo Clinic researchers highlighted the importance of early detection for improving the efficacy of minimally invasive procedures. In the early stages, uterine fibroids are less extensive, making treatment less medically complicated.

Notably, women are at an increased risk of uterine fibroids as they age, with Black women experiencing the greatest risk and experiencing more severe fibroids. According to Ebbie Stewart, MD, Mayo Clinic gynecologist and co-lead author, early diagnosis and treatment may mediate this health disparity.

Surveys have also indicated a preference for minimally invasive procedures among Black women. Investigators recommended further research targeting younger and Black women, along with individuals who have a strong family history of fibroids, to determine the impact of early treatment on long-term risks.

This data is supported by a study from the American Journal of Obstetrics and Gynecology reporting increased symptom burden among open hysterectomy patients when using enhanced recovery after surgery (ERAS).² Participants received either open hysterectomy or minimally invasive surgery (MIS) using ERAS surgical care.

ERAS included preoperative carhobydrate loading, skin preparation, and premedication with acetaminophen, celecoxib, tramadol, pregabalin, and venothromboembolic prophylaxis with heparin. During the operation, patients underwent goal-directed fluid therapy, normothermia, and weight-based injection of local anesthetic.

Following the operation, patients received opioid-sparing, multimodal analgesia with scheduled acetaminophen and ibuprofen, early ambulation, and feeding on postoperative day 0. Symptom burden was measured using the MD Anderson Symptom Inventory.

The open surgical cohort had a median length of hospital stay of 3 days, vs 0 days in the MIS cohort. Thirty-day remission rates were 2.5% vs 1.2%, respectively, and a higher overall complication rate was reported in the open surgical cohort.

Overall pain scores were 54.1% in the open surgical cohort and 28% in the MIS cohort. Abdominal pain scores were 34.5% vs 7.2%, respectively, fatigue 45% vs 30.6%, respectively, lack of appetite 23% vs 11.8%, respectively, bloating 18.7% vs 6.6%, respectively, and constipation 25.4% vs 11.2%, respectively.

These results indicated worse postoperative outcomes from open hysterectomy vs MIS procedures. This supports the recommendations from Mayo Clinic researchers to prioritize minimally invasive procedures.

References

1. Mayo Clinic researchers recommend alternatives to hysterectomy for uterine fibroids, according to study. EurekAlert. November 6, 2024. Accessed November 7, 2024.
2. Krewson C. Open vs minimally invasive hysterectomy outcomes with enhanced recovery after surgery. Contemporary OB/GYN. February 21, 2024. Accessed November 8, 2024. https://www.contemporaryobgyn.net/view/open-vs-minimally-invasive-hysterectomy-outcomes-with-enhanced-recovery-after-surgery