Options For Fibroid Treatment | Fibroid Removal

In this detailed video, Dr. Elizabeth Coronado describes the types of fibroids and the options for safe removal. She discusses the steps that should be taken, as well as the communication that needs to occur between the radiologist, surgeon and patient.

Dr. Coronado explains the following:

  • 50% of all women have uterine fibroids.
  • Fibroids can grow to become large and cause heavy periods and pain.
  • Fibroids are muscle-tumors in the uterus that form a round ball.

The YouTube takes us through the steps taken for one patient with multiple uterine fibroids.

The first step is the ultrasound.

  • Ultrasounds will pick up many, but not all fibroids.

The 2nd step is the MRI.

  • Shows greater detail in a sagittal image
  • Helps give the exact shape and size
  • Shows all of the fibroids, not just the large ones shown on ultrasound
  • Helps the radiologist create a map for the surgeon to locate all of the fibroid tumors

The 3rd step is the discussion with the patient.

  • In this case, Dr. Coronado recommended a procedure called the Acessa procedure, a less invasive procedure that inserts a needle into the fibroid tumor and reduces it via radio waves.
    • The patient’s insurance refused to pay for acessa. Dr. Coronado and the patient decided to proceed with the removal (without acessa) in the safest way possible.

Different types of fibroids:

  • 1 in 10,000 are cancerous.
    • An MRI can tell the doctor is the tumor is benign
  • Pedunculated fibroids
    • Easiest to remove.
    • Attached to the uterine wall via a stalk-like structure called a peduncle.
    • Can grow inside and outside of the uterus.
  • Subserosal fibroids
    • Form on the outside of the uterus.
    • Can grow large enough to make the womb look bigger on one side
  • Mucosal fibroids (submucosal)
    • Develop in the middle muscle layer (uterine lining)
    • Can cause a lot of damage
    • Not as common
    • Causes heavy bleeding
    • Most often the advice is a hysterectomy with this type of fibroid

Doctor Coronado shows the steps to safely remove uterine fibroids including:

  • Use hemostatic agent to prevent bleeding
  • MUST remove fibroids in a contained bag to avoid contamination
  • Take the time to complete the removal safely
  • Use “Pearls on a string” technique
  • Use cauterization where necessary
  • Robotic assisted surgery is the best for fibroid removal.