title: Uterine-sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta-analysis.
abstract: OBJECTIVE
  To evaluate the effectiveness of uterine-sparing interventions for women with symptomatic uterine fibroids who wish to preserve their uterus.
  
  
  METHODS
  Systematic review and indirect comparison meta-analysis.
  
  
  METHODS
  MEDLINE, EMBASE, CENTRAL, conference proceedings, trial registers and reference lists were searched up to October 2013 for randomized controlled trials.
  
  
  METHODS
  Outcome measures were patient satisfaction, re-intervention and complications rates, reproductive outcomes, and hospitalization and recovery times.
  
  
  RESULTS
  Five trials, involving 436 women were included; two compared uterine artery embolization with myomectomy and three compared uterine artery embolization with laparoscopic uterine artery occlusion. Indirect treatment comparison showed that myomectomy and uterine artery embolization resulted in higher rates of patient satisfaction (odds ratio 2.56, 95% credible interval 0.56-11.75 and 2.7, 95% credible interval 1.1-7.14, respectively) and lower rates of clinical failure (odds ratio 0.29, 95% credible interval 0.06-1.46 and 0.37, 95% credible interval 0.13-0.93, respectively) than laparoscopic uterine artery occlusion. Myomectomy resulted in lower re-intervention rate than uterine artery embolization (odds ratio 0.08, 95% credible interval 0.02-0.27) and laparoscopic uterine artery occlusion (odds ratio 0.08, 95% credible interval 0.01-0.37) even though the latter techniques had an advantage over myomectomy because of shorter hospitalization and quicker recovery. There was no evidence of difference between the three techniques in ovarian failure and complications rates. The evidence for reproductive outcomes is poor.
  
  
  CONCLUSIONS
  Our study's results suggest that laparoscopic uterine artery occlusion is less effective than uterine artery embolization and myomectomy in treatment of symptomatic fibroids. The choice between uterine artery embolization and myomectomy should be based on individuals' expectations and fully informed discussion.
authors.affiliation: Obstetrics & Gynaecology Department, Leigh Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Leigh, UK.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Panagiotopoulou
authors.forename: Shankaralingaiah
authors.initials: S
authors.lastname: Nethra
authors.forename: Stamatios
authors.initials: S
authors.lastname: Karavolos
authors.forename: Gaity
authors.initials: G
authors.lastname: Ahmad
authors.forename: Andreas
authors.initials: A
authors.lastname: Karabis
authors.forename: Amanda
authors.initials: A
authors.lastname: Burls
mesh_terms: D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery / Q000628:therapy*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000601:surgery / Q000628:therapy*; D014599:Uterus / Q000601:surgery*
keywords: Uterine sparing surgery; fibroids; indirect treatment comparison; myomectomy; uterine artery embolization; uterine artery occlusion