CRYOMYOLYSIS, A NEW PROCEDURE FOR THE CONSERVATIVE TREATMENT OF UTERINE FIBROIDS

Conservative surgical options for uterine myomata traditionally were a bdominal myomectomy, laparoscopic myomectomy, and, more recently, myol ysis. Each of these procedures has distinct advantages, bur also appar ent disadvantages. We attempted to introduce an additional option for conservative surgical treatment of fibroids by freezing the structures , a procedure termed cryomyolysis. In this pilot study, 14 women were pretreated with a gonadotropin-releasing hormone (GnRH) agonist for a minimum of 2 months preoperatively to minimize uterine and myoma size. Cryomyolysis was performed and the GnRH agonist was discontinued. Mag netic resonance imaging scans were performed in 10 of the 14 women aft er GnRH agonist treatment but before surgery, and 4 months postoperati vely. Total uterine volume ranged from 41.3 to 1134.8 mi preoperativel y, and 49.5 to 1320 mi postoperatively (mean increase 22% after discon tinuation of GnRH agonist). Normal uterine volume ranged from 35.6 to 548.7 mi preoperatively and 45.1 to 729.6 mi postoperatively (mean inc rease 40%); however, myoma volume showed a mean decrease of 6% (range- 87-28%). Analysis of only frozen myomata revealed a mean volume decrea se of 10%. Cryomyolysis maintains at or slightly reduces these lesions to post-GnRH agonist size, and all other uterine tissue returns to pr etreatment size. We believe cryomyolysis may be an effective conservat ive surgical approach to uterine fibroids.