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UFE vs. Surgery

If you could ease fibroid symptoms with a simple nonsurgical procedure, would you do it? 

It’s a question many women would scoff at - but in fact, such a therapy does exist. It’s called uterine fibroid embolization (UFE) and it’s a minimally invasive procedure that treats fibroids without causing physical trauma to the body. No scars, no stitches, or invasive surgery are involved. Studies show a significantly high success rate in achieving fibroid shrinkage, reducing heavy menstrual bleeding, and significantly improving bulk symptoms like pain, pressure, and discomfort. 

Here’s how it works and how it differs from surgical procedures:

Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) is an image-guided, minimally invasive procedure that is performed by an interventional radiologist. During this hour-long procedure, the patient is placed under moderate sedation, after which point the interventional radiologist makes a tiny incision - 1.5 millimeters - in the upper thigh or wrist in order to go in with a very thin catheter and make their way into the uterus to locate and block the arteries that are feeding the fibroids blood.

Using embolic agents the size of grains of sand, the radiologist is able to create a physical barrier in order to stop the blood flow to the fibroids. This blood supply is the reason fibroids are able to grow and cause symptoms. Without their blood supply, the fibroids begin to shrink and symptoms diminish over time. This is when patients see a dramatic decrease in many of the symptoms associated with their fibroids. 

In many cases, UFE eliminates the need for surgical intervention. The procedure itself takes one- to one-and-a-half of hours to perform, followed by a two- or three-hour recovery. Women leave the same day accompanied by an escort. They are typically ready to resume all activities and return to work within 5-7 days after the procedure. It's a uterus-preserving procedure that is also a good option for women who wish conceive.

 

Surgical Procedures 

Among the surgical procedures that exist to treat fibroids, women can opt to have their fibroids removed or their uterus removed to prevent fibroids from growing back. There are numerous benefits both procedures offer, but both also carry the risks of open surgery, including significantly longer recovery times, more pain, and a higher risk for complications.  

Myomectomy - Myomectomy is the surgical removal of fibroids. This is an attractive treatment option because it relieves symptoms and preserves the uterus. However, research indicates that women who have multiple fibroids removed through myomectomy are significantly more likely to have new fibroids grow in their place. 

A study published in the Journal of Obstetrics & Gynecology assessed recurrence rates of fibroids removed through myomectomy in 145 consecutive cases over a five-year period, and found that the cumulative probability of recurrence was significantly lower in patients with a single fibroid removed (11%), compared with patients with multiple fibroids (74%).

Hysterectomy - Hysterectomy continues to be the most prescribed fibroid treatment option for obvious reasons. It eliminates fibroid recurrence and permanently relieves symptoms. However, it also results in a loss of fertility and early menopause due to hormonal changes. Longer-term side effects, both physical and psychological have been reported. The risks associated with surgery and general anesthesia are also more dramatic than with UFE. There is approximately a two to six-week recovery.

How Invasive are Myomectomy/Hysterectomy? 

Open Surgery (Abdominal Myomectomy or Hysterectomy)

This major surgery may be recommended to patients who have numerous or very large fibroids growing in the walls of the uterus. During this procedure, the surgeon makes an open abdominal incision to access the uterus and remove fibroids. Most surgeons prefer to make a low, horizontal ("bikini line") incision, if possible. However, vertical incisions (from the belly button to the pubic bone) are sometimes needed for larger uteruses. 

If the procedure is a myomectomy, after the procedure is done, the uterine muscle is sewn back together using several layers of stitches. This surgery is performed under full anesthesia. Most women spend two nights in the hospital and four to six weeks recovering at home. After the procedure, most patients will have a four-inch horizontal scar near their "bikini" line. 

Conventional Laparoscopic Surgery (Laparoscopic Myomectomy or Hysterectomy)

This major surgery may be recommended to patients who have smaller and fewer fibroids. During this procedure, the surgeon makes a small incision near the patient’s belly button and inserts a laparoscope (a slender narrow lighted tube fitted with a camera) into the abdomen. The surgeon removes the fibroids using instruments inserted through the small incisions in the abdominal wall. This surgical procedure is performed under full anesthesia.

Compared with women who have abdominal myomectomy, women who undergo laparoscopic myomectomy have less blood loss, shorter hospital stays and recovery, and lower rates of complications and less scarring after surgery. Most women spend two nights in the hospital and two to four weeks recovering at home.

Robotic Laparoscopic Surgery (Robotic Laparoscopic Myomectomy)

This major surgery may also be recommended to patients who have smaller and fewer fibroids. During this surgery, the surgeon controls the instruments remotely using a robotic arm. Because the incisions used in robotic myomectomy are so small, this procedure works best with smaller uterine fibroids, which are easier to extract.

The surgeon makes a small incision near the patient’s belly button and inserts a laparoscope into the abdomen. The surgeon removes the fibroids using the instruments inserted through small incisions in the abdominal wall.

Robotic surgery may take more time to perform, so the patient remains under full anesthesia longer, but otherwise there are very few differences between the two treatment options.

Our VIVA EVE Promise

At VIVA EVE, we help you select the treatment plan that aligns with your treatment goals. While hysterectomy is commonly recommended for fibroid treatment, studies show that it is over-prescribed.

In a University of Michigan study conducted in 2015, researchers examined the medical records of 3,397 women at 52 different hospitals who underwent hysterectomies for benign conditions. Nearly 40% of records failed to include any documentation of alternative treatments used or recommended before the hysterectomy was performed. Fewer than 30% of the women received medical therapy, and just 24% of women underwent other minor surgical procedures before the hysterectomy. 

VIVA EVE specializes in minimally invasive fibroid treatment but as a multi-specialty clinic, we also provide access to surgical procedures. We vow to always recommend the course of treatment that is best for you and your unique circumstances. 

To book an appointment, visit our schedule consultation page

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