Fibroid removal could prevent unnecessary hysterectomies

When Sherry Nicklaus was diagnosed with uterine fibroids, her doctor had one recommendation: remove her uterus.

Nicklaus recoiled at the idea of having major surgery to cut out an organ of her body. Her doctor didn't discuss alternatives, but tried to tempt her by saying, "I'll make you go down two dress sizes."

Nicklaus was livid. As a former pharmaceutical saleswoman, she knew doctors are required to tell patients about all reasonable alternatives for treatment.

"I remember leaving terrified and upset," she said. "I knew the fibroids weren't life-threatening, they were benign, but they're annoying."

Eventually, Nicklaus, 46, of Geneva, found Dr. Jonathan Song at Delnor Hospital in St. Charles. He offered her a less invasive option: laparoscopic myomectomy. He uses two or three half-inch incisions to insert surgical instruments and a tiny camera to cut out just the fibroids, or myomas.

Like most of Song's patients, Nicklaus was out of the hospital that day, and back to normal in two days - much faster than a hysterectomy, which typically takes several days in the hospital and a month or two of recovery.

At some point in their lives, 70 to 80 percent of women will have fibroids, though only some of them will ever have symptoms like excessive menstrual bleeding and pelvic pain or pressure.

Each year, about 600,000 women in the United States have hysterectomies, which can deplete the body's hormones and cause depression and other side effects.

One-third to a half of hysterectomies are for fibroids, according to the National Uterine Fibroids Foundation.

Song believes minimally invasive fibroid removal could prevent unnecessary hysterectomies for fibroids. He uses an innovative technique which cuts the fibroids into smaller pieces so they can be removed. After some initial resistance, the procedure is gaining wider acceptance among doctors.

This year, the American College of Obstetrics & Gynecology awarded first prize to Song and Drs. Carlos Rotman and Edgardo Yordan of the Oak Brook Institute of Endoscopy for their medical video of their procedure.

The patient in the video was able to recover to have a child and got pregnant again this year.

Some doctors reserve fibroid removal as a way to save the uterus for women who want to have children, or for those with only a single small fibroid.

But Song believes all women, even those after menopause and those with numerous large fibroids, should have the option of avoiding hysterectomy.

Dr. William Parker, a UCLA professor and author of "A Gynecologist's Second Opinion," has written that laparoscopic surgery has "revolutionized" gynecologic surgery by speeding up recovery time and shortening hospital stays.

Because laparoscopic myomectomy is a technically difficult procedure, Parker recommends asking a surgeons how they were trained in it, how many such operations they've performed with a situation like your own, and what complications they ran into.

"I think we're doing too many unnecessary hysterectomies," Song said, "because not enough doctors can do other procedures."

There are no randomized studies to be sure which treatments have the best long-range outcomes, but fibroid removal is gaining in popularity.

Dr. Howard Sharp at the University of Utah says more doctors are becoming proficient at stitching up the uterus after such procedures, and the advance of robotic surgery is helping to make that easier.

Dr. Charles Miller, in Arlington Heights and Naperville, is one of the leading practitioners, he added.

"I still don't think every doctor is going to do it," he said, "but there may be a time when laparoscopic myomectomy is more mainstream."

At Central DuPage Hospital in Winfield, Dr. Victor Trinkus performs hysterectomies, and works with other doctors to provide alternative treatments.

One alternative is embolization, in which an interventional radiologist inserts a catheter to plug up blood vessels feeding the fibroids, causing them to shrink.

Trinkus hopes to reach women who avoid treatment altogether because they're afraid hysterectomy is the only option.

"Patients need to hear there are other options," he said. If symptoms are manageable, he added, surgery may not be necessary at all.