Maiden Lane Medical – Gynecologists located in New York, NY
As a team of leading gynecologists in the greater New York City area, Maiden Lane Medical offers women the most advanced treatments for uterine fibroids so they can find relief from symptoms of pain and irregular bleeding and reduce their chances for pregnancy complications.
What are fibroids?
Fibroids, also known as leiomyomas or myomas are growths of muscle tissue throughout the wall of the uterus. The exact cause of fibroids is unknown but they are affected by hormones and genetics. It is estimated up to 80% of women have fibroids, although only a minority of women will have symptoms.
What are some of the symptoms of fibroids?
In general, symptoms of fibroids include:
– Increase in the amount and length of bleeding with your period – this is called menorrhagia.
– Pressure in the pelvis
– More frequent urination
– Bulge in lower abdomen
– Uncomfortable intercourse
– Sometimes infertility (lack of ability to become pregnant)
– Need to go to the bathroom urgently
How are fibroids diagnosed?
Fibroids can be diagnosed with a physical exam and pelvic ultrasound (similar to that used in pregnancy). Often an MRI (magnetic resonance imaging) is performed to delineate the exact locations, number, and size of fibroids.
Fibroids can be located in many locations in the uterus. The most common location is in the wall or muscle of the uterus. These are called intramural (inside the wall) fibroids. They can also be located inside the cavity of the uterus. These are called submucosal fibroids. Finally they can be located outside of the wall of the uterus underneath the outside lining of the uterus – the serosa. These fibroids are called subserosal. One type of subserosal fibroid commonly seen is a pedunculated fibroid. This type of fibroid sits outside the uterus on a stalk.
Who is at risk for developing fibroids?
There are some specific types of patients who may be at higher risk for developing fibroids than others. Please understand, the majority of fibroids – especially smaller fibroids – tend to not cause any symptoms. So, in our discussion about fibroids I will refer to patients who have symptoms from fibroids.
The lifetime risk (cumulative incidence) of fibroids varies among ethnic groups. For example, black women tend to have a lifetime cumulative incidence of developing fibroids, around 80%. This means that at some point from birth to death a black woman has an 80% chance of having a fibroid. This includes both symptomatic and asymptomatic fibroids. For white non-hispanic woman, that cumulative incidence number falls to around 60-70% and for Asian woman it is even lower. Although the true cumulative incidence of fibroids among Asian women is not well known.
We do our best to avoid having to do a hysterectomy.
What are the surgical techniques for managing fibroids?
There are several different surgical approaches to managing fibroids. The decision to have surgery versus having medical therapy depends on many factors.
Our job is to educate you and let you decide.
Factors that may be associated with a decision for medical versus surgical therapy include:
– severity of symptoms (bleeding, pain, pressure, urinary symptoms)
– desire to become pregnant (either soon or longer into the future)
– size of fibroids
– location of fibroids
– prior surgical history
– other medical conditions
In general, in our practice we do our best to avoid counseling a patient to perform a hysterectomy unless it is absolutely necessary because of some other medical issue or simply because the patient wants it.
There are 2 main surgical procedures that can be performed to remove fibroids. They are myomectomy and hysterectomy. In addition there is a class of procedures that can be performed to decrease or eliminate the severe bleeding associated with fibroids. Those procedures are called global endometrial ablation (GEA).
Global Endometrial Ablation
Global endometrial ablation (GEA) procedures are very simple and very effective procedures. There are many ways to perform a GEA. One can use heat, electrical energy, or cold. We prefer to use the hot water (Thermachoice) or electrical energy (Novasure) techniques. We feel these techniques are the most effective and the best tolerated by patients. We have performed thousands of these procedures with excellent results.
There are several advantages to having a GEA
– There are no incisions
– It can be performed right in our office with light sedation and local anesthesia
– While no outcome is guaranteed there is a >90% satisfaction rate.
– And the best part… NO HYSTERECTOMY.
Hysterectomy is a procedure in which the uterus is removed. This can be done without removing the cervix. Many women prefer to leave the cervix in. Although, there is no evidence of any medical or sexual function benefit to doing this. I often see patients who are confused about the definition of a hysterectomy. please remember, a hysterectomy is the removal of the uterus only. Removing the uterus DOES NOT mean the ovaries will be removed as well. The vast majority (>95%) of our patients do not require removal of the ovaries at the time of hysterectomy. The ovaries are where important hormones are made. Thus, leaving the ovaries inside means you will not go into menopause immediately after your surgery.
We do our best to avoid having to do a hysterectomy.
Myomectomy is a procedure during which fibroids are removed. There are several ways to perform myomectomy and the technique depends mainly on the location and size of the fibroids.
Hysteroscopy with myomectomy is when we place a camera inside the uterus. We can then using a very small cutting device to remove the fibroid from the cavity of the uterus very carefully without causing damage to the remainder of the lining of the uterus. This is a big advantage over older methods of hysteroscopic myomectomy which were done with electrical energy and may have caused damage to the lining of the uterus. Most of the time hysteroscopy with myomectomy is being performed in women who are planning to have children. Thus, using our technique of directed cutting without electrical energy there is minimal damage to the endometrium, which works very well for this group of patients.
Laparoscopic / robotically assisted (daVinci) myomectomy is a procedure in which multiple small incisions are made in the abdomen and the fibroids (even very large ones) are then removed. There are a lot of benefits to this procedure. In particular, for women who are planning to maintain their fertility and desire a minimally invasive approach this is a very good option.
Some of the benefits to this procedure include:
– Less blood loss than traditional open myomectomy and less blood loss than standard laparoscopic myomectomy
– Faster return to work and normal function than open myomectomy
– Less pain versus open myomectomy
– Improved suturing technique versus standard laparoscopic myomectomy
– Most patients will go home the same day
Dr. Levey serves as a proctor at NYU’s Robotic Surgery Center and frequently has visitors from around the United States come to NYU to learn from his surgical technique.
Abdominal (open) myomectomy is a procedure during which fibroids are removed from a fairly large incision in the lower abdomen. The vast majority of the time we are able to perform a robotic / daVinci myomectomy. We are experts in doing so. If an open myomectomy is indicated, we are able to minimize the size of your incisions (we almost never have to make large vertical incisions) and often patients are able to go home the next day.
Dr. Levey was the first surgeon to perform robotic myomectomy at NYU Langone Medical Center.