Big size fibroid uterus management .pptx

Management of big size fibroids

1. Tackling Big Size Uteri : Robotic Approach Tanushree Rao Liverpool Hospital and Macquarie University Hospital

2. Introduction to Fibroids Definition: Fibroids, also known as uterine leiomyomas or myomas, are noncancerous growths of the uterus that often appear during childbearing years Economic burden: Treating fibroids leads to substantial healthcare costs and productivity losses, impacting economies. Racial disparities: Studies show variations in fibroid incidence among different racial groups, highlighting disparities.

3. Pathogenesis

4. Symptoms of Fibroids Common Symptoms of Fibroids: Symptoms such as heavy menstrual bleeding, pelvic pain affect daily life, pressure symptoms, infertility, degeneration and urinary retention. Quality of Life Impact: Fibroid symptoms can lead to fatigue, anaemia, and emotional distress, impacting well-being.

5. Diagnosis of Fibroids Ultrasound for Fibroid Diagnosis: Ultrasound is non-invasive, cost-effective, and allows real-time visualization of fibroids. MRI in Fibroid Diagnosis: MRI provides detailed images for precise fibroid localization and characterization. LDH for Sarcoma Detection: LDH aids in distinguishing sarcomas from benign fibroids for appropriate treatment.

6. Management of Fibroids Implementing Multidisciplinary Fibroid Clinics: Collaborative care improves treatment outcomes through combined expertise from various medical specialties. Medication Therapy: Pharmacological options like hormonal treatments can help manage fibroid symptoms effectively. Minimally Invasive Procedures: Procedures such as uterine artery embolization offer less invasive alternatives to surgery. Surgical Interventions: Surgical procedures like myomectomy or hysterectomy may be necessary for severe cases.

7. Medical Management AUB: TXA, mefenamic acid, Primolut Benefits of Mirena for Fibroids: Mirena offers long-term symptom relief and reduces heavy menstrual bleeding. Advantages of GnRHa in Fibroid Management: Ryeqo / Zoldex provides non-surgical treatment options. Uterine Artery Embolisation (UAE): UAE is a minimally invasive procedure reducing fibroid size and improving symptoms. Radiofrequency ablation and ultrasound focussed ablation

8. Mechanism of Action of Ryeqo Introduction: Ryeqo is an oral medication for treating moderate to severe symptoms of uterine fibroids. Components: Relugolix : - Non-peptide GnRH receptor antagonist. - Inhibits GnRH receptors in the anterior pituitary. - Reduces release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). - Prevents follicular growth and ovulation. - Decreases estrogen and progesterone production. Estradiol: - Synthetic estrogen. - Alleviates symptoms associated with hypoestrogenic state. Norethisterone Acetate: - Synthetic progestogen. - Protects the endometrium from hyperplasia.

9. Benefits of Ryeqo in Uterine Fibroids Treatment Efficacy: - Significant reduction in menstrual blood loss by 73% in clinical trials. - Improvement in hemoglobin levels in women with anemia . - Reduction in pain and discomfort associated with fibroids. Clinical Trial Results: - Phase 3 trials (LIBERTY 1 and 2): - Participants: Premenopausal women aged 18-50 with heavy menstrual bleeding due to fibroids. - Primary endpoint: Reduction in menstrual blood loss. - Secondary endpoints: Reduction in pain, improved quality of life. Safety: - Similar adverse event rates as placebo. - Most common adverse effects: hot flushes, headache, and hypertension. - No significant changes in bone mineral density over 24 weeks. Convenience: - Oral administration. - Non-surgical option.

10. Hysteroscopic Resection Indications for Hysteroscopic Resection: Hysteroscopic resection is indicated for submucosal fibroids causing infertility or abnormal uterine bleeding. Procedure Overview of Hysteroscopic Resection: Hysteroscopic resection involves the removal of fibroids through a hysteroscope, minimizing invasiveness and promoting quicker recovery. Benefits of Hysteroscopic Resection: Hysteroscopic resection preserves the uterus, enhances fertility, and reduces the risk of complications compared to traditional surgery.

11. Robotic Myomectomy Indications for Robotic Myomectomy: Robotic myomectomy is recommended for large or multiple fibroids, preserving fertility and reducing blood loss. Procedure Overview of Robotic Myomectomy: Robotic myomectomy utilizes minimally invasive robotic technology for precise fibroid removal, improving surgical outcomes. Benefits of Robotic Myomectomy: Robotic myomectomy offers faster recovery, shorter hospital stays, and minimal scarring, enhancing patient satisfaction.

12. Robotic Hysterectomy : What I need MRI: to rule out sarcoma, DIE and to get a mental picture Uterine Manipulator (can be done without): RUMI manipulator Plan port placements Use of Indocyanine Green (ICG): ICG enhances visualization during robotic hysterectomy, aiding in precise tissue identification Role of Ureteric Stents: Ureteric stents reduce the risk of ureteral injury during fibroid removal, ensuring safety Importance of Including a Surgical Video: A surgical video provides a valuable educational tool for understanding the procedure intricacies A good team : Most important

13. Robotic Port placements

14. Robotic Port placements

15. Concept of cone I initially came across this concept through Dr. Devin Garza .

16. Morcellation and Sarcoma Risks Risks of Morcellation in Myomectomy or Hysterectomy: Morcellation can lead to the spread of unexpected cancerous cells, increasing patient morbidity and mortality rates. Recommendations for Morcellation Use: Careful patient selection, preoperative assessment, and clear consent discussions are crucial to minimize risks associated with morcellation. Guidelines for Morcellation Procedures: Adherence to established guidelines on proper tissue extraction techniques and close postoperative monitoring is essential for safe morcellation practices.

17. Conclusion Advancements : Emerging medications provide new treatment options, while techniques such as robotic myomectomy allow for precise fibroid removal with minimal scarring. Await introduction of radiofrequency ablation (Accessa/Sonata) in Sydney. Personalized Medicine in Fibroid Management: Tailoring treatment can optimize outcomes and patient satisfaction. Integrated Care Approach for Fibroid Patients: Holistic approaches combining medical, surgical, and psychological support improve overall well-being.

18. Patient at the centre Addressing Patient Concerns Effectively: Clear communication and empathy enhance patient satisfaction and treatment adherence. Importance of Multidisciplinary Teams: Collaboration between specialists optimizes fibroid management, ensuring comprehensive care. Adapting Treatment Plans for Individual Needs: Personalized approaches consider patient preferences and medical nuances for improved outcomes.

19. Questions? [email protected]