2 The procedure

2.1 Indications

2.1.1 Laparoscopic laser myomectomy is used to treat uterine fibroids, also known as uterine leiomyomas or uterine myomas. Fibroids are benign tumours of the uterine muscle. They are very common and are often asymptomatic. They may cause abnormal bleeding, pelvic pressure and pain, and reproductive problems.

2.1.2 Hysterectomy is the standard treatment for women with fibroids whose symptoms have not resolved with medical treatment.

2.2 Outline of the procedure

2.2.1 Laparoscopic laser myomectomy destroys fibroids using a laparoscope passed through a small incision in the abdomen and then through the wall of the uterus. The fibroids are destroyed with a laser. For more details refer to the sources of evidence section.

2.3 Efficacy

2.3.1 The evidence reviewed was of poor quality and did not clearly report efficacy outcomes, particularly outcomes relating to symptomatic relief. For more details refer to the sources of evidence section.

2.3.2 The Specialist Advisors noted that the indications for this treatment were unclear, which made it difficult to assess its efficacy. One Advisor noted that the procedure was suitable only for removing relatively small fibroids, which tend to be asymptomatic, and therefore questioned the clinical value of the procedure.

2.4 Safety

2.4.1 The evidence reviewed was too limited to establish the safety of this procedure. For more details refer to the sources of evidence section.

2.4.2 The Specialist Advisors reported that there are risks associated with the use of both laparoscopic and laser surgery, including bowel and urinary tract damage, and rupture of the uterine scar during subsequent labour.

2.5 Other comments

2.5.1 Fibroids that are symptomatic are generally of a size and location that would make treatment by laparoscopic laser myomectomy difficult.

Andrew Dillon
Chief Executive
November 2003