Minimal-access therapy in symptomatic myomata and
adenomyosis has proved to be gold standard in the surgical
management . Pure medical treatment showed to be effective
on a short or middle term time frame but influences hormonal
homeostasis or even potentially provokes severe adverse effects
; thereby it couldn’t succeed to become the treatment of choice.
In the last decades, we could see an evolution in the surgical cancer
therapy, from ultraradical surgery with laparotomy, to minimalinvasive
techniques as way of entrance, now proceeding to tailored
operations with concomitant chemo- or immunotherapy. This
individualized concept also seems to be adaptable to the treatment
of benign uterine wall diseases. Coming from laparotomy with
eventually hysterectomy, reducing the impact on body image
by minimal-access myomectomy, newer even less traumatizing
possibilities are emerging. Besides the uterine artery embolization,
bearing the risk of a major uterine necrosis, a more selective nonsurgical
therapy has emerged.
In Asia numerous centers have successfully completed therapy
of symptomatic fibromata by high-frequency ultrasound ablation.
Also in urological diseases, positive European experiences have
been published . In sedation, after localizing the myoma by
diagnostic echography, eventually combined with a preoperatively
performed MRI, the tumor is destroyed by therapeutic ultrasound.
This allows to avoid any cutting interventions and leaves the
complete management in the hand of the gynecologist. The highest
experience comes out of China, Singapore, Korea, Taiwan, and
seems promising, also for Europe. Therefore, the European Society
for Gynecological Endoscopy with over 6,000 members in more
than 70 countries has inaugurated a working group to evaluate
this technique, especially for European women. The safety profile
and long-term efficacy will be evaluated and documented, to allow
further distribution of this promising technique.
As reduced trauma is leading to enhanced quality of life, every
possible improvement in medicine should be carefully evaluated to
allow further improvement of patient care.