The Benefits and Limits of Laparoscopic Surgery for Uterine Fibroids

This study is currently recruiting participants.
Verified June 2010 by Taipei Veterans General Hospital, Taiwan
Sponsor:
Information provided by:
Taipei Veterans General Hospital, Taiwan
ClinicalTrials.gov Identifier:
NCT00860002
First received: March 10, 2009
Last updated: June 6, 2010
Last verified: June 2010
  Purpose

Uterine leiomyomas (i.e., fibroids, myomas) are the most common gynecologic tumors in women of reproductive age (1). Clearly, the majority of such lesions are asymptomatic (2). Symptoms directly attributable to these benign tumors represent the most common reason for laparotomy in non-pregnant women in the United States (3,4), and also in Taiwan (5). Whereas in decades past, hysterectomy was seen almost as a panacea for uterine leiomyomas, more recently attention has been paid to the development of pharmaceutical agents and less-invasive procedures (6). Frequently, such procedures are designed to retain the uterus (6). Of these, myomectomy may be a choice among the uterine-sparing treatments for symptomatic uterine myoma (7,8).

The surgical mode of access usually employed in myomectomy is traditional exploratory laparotomy or its modification—mini-laparotomy (MLT) (9) or ultra-mini laparotomy (UMLT) (10,11), though recently, laparoscopy (12-14) or a combination of laparoscopy and MLT (9), vaginal surgery (15), and hysteroscopic myomectomy (16-21) have represented valid alternatives. However, myomectomy alone provides varying degrees of symptom control and a high percentage of recurrence, not only for the tumors themselves, but also for the symptoms. For example, one study reported that symptom resolution varied from 84.0% to 100% depending on different items and 21 (19.4%) of 108 patients experienced a recurrence after an average interval of 16 months (range, 1.8-47.4 months) (22). Therefore, an alternative or additional therapy might be required to provide longer durable symptom control and minimize tumor recurrence. One of the strategies is laparoscopic uterine vessel occlusion (LUVO), also known as laparoscopic uterine artery occlusion (LUAO) (23,24).

The rationale for using LUVO in the management of symptomatic myomas is found in the successful experience with uterine-artery embolization (UAE), which was introduced in 1995 as an alternative technique for treating fibroids (25). Since then it has become increasingly accepted as a minimally invasive, uterine-sparing procedure, and studies have reported the relief of excessive menstrual bleeding or pressure in 80-90% of patients (26-32). LUVO provided similar relief of symptoms (89.4% with symptomatic improvement and 21.2% with complete resolution of symptoms) in 2001 in a 7- to 12-month follow-up of 87 patients after LUVO (33).

Since that time there has been rapid growth in the use of this treatment with various modifications, such as simultaneous accompaniment with myomectomy either through laparoscopy or ML, and there has been considerable research into its outcome (22,34-42). However, in our previous data, we found that a combination of LUVO and myomectomy provided definite effectiveness in symptom control for these women with symptomatic uterine myomas (98.1% to 100% symptom resolution depending on various kinds of items), minimized tumor recurrence, and rendered the vast majority of re-interventions unnecessary (22). Myomectomy can be performed by the laparoscopic approach or by ML when patients are undergoing the LUVO procedure. Before 2002, we often used ML to perform myomectomy (22). However, we have shortened the incision to less than 4 cm, creating ultramini-laparotomy (UMLT) to perform myomectomy (10,11,43).

Since many conservative therapies might provide less or more therapeutic effects on the symptom control and disease status, the aim of this prospective study tries to evaluate the therapeutic outcomes of these symptomatic uterine myomas after different kinds of therapies in the coming 5 years at Taipei Veterans General Hospital.


Condition
Uterine Fibroids

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: The Benefits and Limits of Laparoscopic Surgery for Uterine Fibroids

Resource links provided by NLM:


Further study details as provided by Taipei Veterans General Hospital, Taiwan:

Primary Outcome Measures:
  • Surgical technique, patient suffering, and outcomes (symptom control, relapse of symptoms, re-intervention, regularity of menstrual cycles and pregnancy outcome) in both groups. [ Time Frame: 2-years and 5 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 1200
Study Start Date: January 2009
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
Groups/Cohorts
1
Ultramini laparotomy (UMLT) myomectomy (UMLT-M) versus laparoscopic myomectomy (LM)
2
Laparoscopically aided myomectomy (LAM) versus LM
3
LAM versus UMLT-M
4
Mini laparotomy myomectomy (ML-M) versus UMLT-M
5
Laparoscopic uterine artery occlusion with blockage of anastomosis between the uterine and ovarian vessels (LUVO) versus laparoscopic uterine artery occlusion without blockage of anastomosis between the uterine and ovarian vessels (LUAO)
6
LUVO+LAM versus LUAO+LAM
7
LUVO+LM versus LUAO+LM
8
LUVO+UMLT-M versus LUAO+UMLT-M
9
LUVO versus UMLT-UVO
10
UMLT-UVO versus UMLT-UAO
11
LUAO versus UMLT-UAO
12
UMLT-UVO+UMLT-M versus UMLT-UAO+UMLT-M
13
LUVO versus LM
14
LUVO versus LAM
15
LUVO versus LUAO+LM
16
LUVO versus LUAO+UMLT-M
17
LUVO versus LUAO+LAM

  Eligibility

Ages Eligible for Study:   20 Years to 60 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Women between 2009 and 2014 booked for treatment who had symptomatic uterine myomas, will be included in the present study. All the treatments for symptomatic uterine myomas, including medical treatment with different kinds of medication, and uterine-sparing surgery including myomectomy, which is performed through traditional exploratory laparotomy (LT), mini-laparotomy (MLT), ultramini-laparotomy (UMLT), laparoscopy (L), the vagina (V) or hysteroscopy (H), and LUVO and combination therapy, and the definite treatment of hysterectomy, through different routes, such as vagina, laparoscopic assistance, and convention exploratory laparotomy. All patients should have uterine fibroids with symptoms, comprising either menstrual problems such as menorrhagia and pain, or compression syndrome, including a bulge-like sensation and frequency. These women will be informed that they can choose to be treated with any one of the above-mentioned procedures, based on their willingness and preference.

Criteria

Inclusion Criteria:

  • symptomatic;
  • having a wish to retain their uterus;
  • an absence of previous abdominal or pelvic surgery;
  • a number of visible uterine masses (myomas) less than or equal to 5 intramural or sub-serous myomas (without peduncle);
  • a maximum diameter of no more than 8 cm;
  • an absence of prominent or significant pelvic adhesion on clinical evaluation; AND
  • at least a 2-year thorough follow-up record available.

Exclusion Criteria:

  • without pathological diagnosis of myoma if the specimen can be obtained; OR
  • any violation the above-mentioned criteria.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00860002

Contacts
Contact: Wen-Hsun Chang, NB 886921125253 whchang@vghtpe.gov.tw
Contact: Ling-Wei Yang, MS 886928994443 sammy680106@hotmail.com

Locations
Taiwan
Peng-Hui Wang Recruiting
201, Section 2, Shih-Pai Road, Taipei, Taipei, Taiwan, 112
Contact: Wen-Hsun Chang, NB    886921125253    whchang@vghtpe.gov.tw   
Principal Investigator: Peng-Hui Wang, M.D., Ph.D.         
Sponsors and Collaborators
Taipei Veterans General Hospital, Taiwan
  More Information

No publications provided

Responsible Party: Peng-Hui Wang, M.D., Ph.D., Associate Professor, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
ClinicalTrials.gov Identifier: NCT00860002     History of Changes
Other Study ID Numbers: VGHIRB-98-01-20A
Study First Received: March 10, 2009
Last Updated: June 6, 2010
Health Authority: Taiwan: Institutional Review Board

Keywords provided by Taipei Veterans General Hospital, Taiwan:
myomectomy
uterine artery occlusion
uterine vessel occlusion
fibroids
leiomyomas
Surgical technique, patient suffering and outcomes

Additional relevant MeSH terms:
Leiomyoma
Myofibroma
Neoplasms, Muscle Tissue
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Connective Tissue
Connective Tissue Diseases

ClinicalTrials.gov processed this record on April 17, 2014