Surgical and radiological management of uterine fibroids--a UK survey of current consultant practice.
BACKGROUND
The aim of this study was to determine the current surgical and radiological management of uterine fibroids by consultants working in the UK.


METHODS
A structured questionnaire was posted to all 1439 UK consultants. Non-responders were sent one reminder. The main outcome measures were surgical route and technique used for myomectomy, and the use and availability of uterine artery embolization (UAE).


RESULTS
Eight hundred fifty-two (59%) consultants replied. Seven hundred thirty-five (86%) admitted to regular sessions of gynecologic surgery, and 75% of this group performed open myomectomy, 16% laparoscopic myomectomy, and 66% hysteroscopic myomectomy. Open myomectomy: Forty-one percent of consultants performed open surgery on uteri equivalent to 12-week gestational age or less, 87% prescribed preoperative gonadotrophin-releasing hormone agonists (GnRHa) in order to reduce surgical bleeding, with 35% using myomectomy clamps, 23% tourniquets, and 19% vasoconstrictors. Laparoscopic myomectomy: The largest uterine size the majority would attempt was equivalent to a 12-week gestation, 58.6% used preoperative GnRHa, 21% used intraoperative vasoconstrictors, and 1.4% tourniquets in order to minimize bleeding. Hysteroscopic myomectomy: As with laparoscopic myomectomy, the largest uterine size the majority would attempt was equivalent to a 12-week pregnancy. Blood transfusion: Twenty per cent, 10%, and 7% reported the need for blood transfusion in up to 10% of patients undergoing open, laparoscopic, or hysteroscopic myomectomy, respectively. UAE: Fifty-one percent have access to UAE and 40% have referred at least one patient in 2001.


CONCLUSIONS
Open and hysteroscopic myomectomy are frequently utilized in contrast to laparoscopic myomectomy. The reported rate of blood transfusion appears low. Although UAE is widely available, the majority of patients are still managed surgically.
Taylor
Alexander
A
Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
Sharma
Malini
M
Tsirkas
Panos
P
Arora
Rohit
R
Di Spiezio Sardo
Attilio
A
Mastrogamvrakis
George
G
Buck
Lucie
L
Oak
Mac
M
Magos
Adam
A
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006489:Hemostatic Techniques / Q000706:statistics & numerical data; D006801:Humans; D015907:Hysteroscopy / Q000706:statistics & numerical data; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009215:Myometrium / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*