Uterine Artery Embolisation: Bringing it back to the Gynaecologist

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Roberta Speyer: “I am Roberta Speyer reporting for OBGYN.net from the ISGE in Cancun. I have the pleasure of having some esteemed physicians here. We’re going to talk about treatment modalities in the treatment of uterine fibroids. Doctors?”

All: “We are Olav Istre from Oslo, Norway; Bjorn Busund from the Gynaecological Department, Ullevaal University Hospital in Oslo; and Anton Langebrekke from the same department in Oslo, Norway.”

Roberta Speyer: “So what’s up with fibroids? What’s new, what is going on?

Olav Istre, MD: “Fibroids is 35% of what gynaecologists treat. In these last years there have been new developments and we have seen that in the United States  radiologists take the patients away from the gynaecologists, there has been a lot of dispute about that.”

Roberta Speyer: “Yes, very controversial.”

Olav Istre, MD: “Very controversial. We actually have tried to see if we could get some of these patients back to us, the gynaecologists.

Roberta Speyer: “I think the women, speaking as a woman, would rather see their gynaecologist than go off to a radiologist. Most women don’t even know what a radiologist is, let alone have one or a relationship with one. So what have you been doing that is helping in bringing those patients back to where they are comfortable with their gynaecologist?”

Olav Istre, MD: “This is an endoscopic congress and we have been treating fibroids conservatively doing endoscopy, laparoscopy, where we do occlusions of the uterine artery and we saw the same effect of reduction of the fibroid size and the reduction in the bleeding intensity and we also found that there was much less pain after the procedure.”

Roberta Speyer: “Did you, do you see this is very similar to the embolisation that the radiologists do, do you have the same results?”

Anton Langebrekke, MD: “Yes, that’s what we are seeing. We have approximately the same results by occluding laparoscopically the artery, the main artery coming in to the uterus, the uterine artery, concerning bleeding reduction and the volume of the myoma, the fibroid.”

Roberta Speyer: “How difficult, or what is the skill level of the learning curve, on doing a procedure like this?”

Olav Istre, MD: “Of course it needs the skilled and trained laparoscopist.”

Bjorn Busund, MD: “Like the embolisation needs a very skilled radiologist! A major thing about fibroids and the patients going to a gynaecologist is that the gynaecologist often can offer all kinds of treatment modalities while the radiologists only have this one thing to offer.”

Roberta Speyer: “With the patients in your clinical setting, or in any that you are aware of, either in the US or in Europe, they are usually going to present to their gynaecologist with this problem and that is when the treatment modality is going to be discussed and decided upon.”

Bjorn Busund, MD: “Yes. It depends on the age, if fertility is an issue, and how big the fibroid is and what the major symptoms are, etc. ”

Roberta Speyer: “The alternative for the patient is what, hysterectomy?”

Bjorn Busund, MD: “It’s hysterectomy, it’s laparoscopic or open myomectomy, or removing the fibroids only. It’s different kinds of occlusion.”

Roberta Speyer: “So with the embolisation what is the recovery time compared to some more traditional methods, even some less invasive types, like hysterectomy?”

Olav Istre, MD: “With a hysterectomy it takes about six weeks to get back to work. Embolisation takes about 10 days I think. With a laparoscopic approach it takes less than a week. So there are some benefits.”

Anton Langebrekke, MD: “I think that concerning the laparoscopic approach the bottom line is not set yet. This is still research but it’s very interesting to see that we can occlude the artery by some way without putting particles like the embolisation is, it’s synthetic particles that spread all the way into the fibroid and even maybe in the mainstream going to the ovaries. We do not know all the results of this. There are reports saying that embolised women will go into menopause or the climacteric symptoms earlier than other women.”

Olav Istre, MD: “But there's another question about the techniques, when you occlude or, do something, when you do an artery it stops the flow to the uterus, for approximately 24 hours and then it returns. That’s very difficult. It has been proven. So what is important is that you have a clotting mechanism inside the fibroid and other tissue. So it seems there might be even simpler procedures in the future. It could be just to temporarily occlude the uterine artery for six hours. They have done some cases with that and it seems that we can achieve the same effect.”

Roberta Speyer: “With much less.”

Olav Istre, MD: “Much less, and no incision.”

Anton Langebrekke, MD: “The theory is once the clotting is done, it’s done. Then the fibroid is suffering.”

Roberta Speyer: “How many cases have you done, now, to date with the endoscopic approach?”

Olav Istre, MD: “We have about 40 cases. It’s part of a randomised controlled study between embolisation and laparoscopy.”

Roberta Speyer: “And where is this going to continue? We’re going to be watching this and seeing the outcome. Are you going to be publishing on this? How many more cases are you planning to randomise?”

Olav Istre, MD: “We actually published the first study now, which has been submitted to the American Journal of Obstetrics.”

Roberta Speyer: “When is that coming out?”

Olav Istre, MD: “It will come out this year.”

Roberta Speyer: “This year?”

Olav Istre, MD: “Hopefully. They accepted it!”

Roberta Speyer: “In what time frame do you think this work is going to go from the research stage to the stage where we could actually see this being utilised in the regular treatment path for women?”

Olav Istre, MD: “We have to wait another year to see the results.”

Roberta Speyer: “But very promising at this time? “

All: “We think so.” 

Roberta Speyer: “We’ll check up with you at the AAGL in the fall in Las Vegas or perhaps next year in Kuala Lumpur, and we’ll find out just where the work is going. Thank you very much gentlemen for participating in this.”

All: “Thank you.”