Uterine fibroids, vitamin D deficiency effects, and misconceptions about pregnancy interference... Improving quality of life through robotic surgery

Uterine fibroids are the most common benign tumors that develop in the uterus. According to the Health Insurance Review & Assessment Service, the number of patients diagnosed with uterine fibroids in medical institutions in 2022 was 607,526, showing an increasing trend each year. In particular, women in their 20s to 40s account for 59.6%. The exact cause of uterine fibroid development has not yet been clearly identified. As a result, there is excessive fear and misinformation about uterine fibroids. A common misconception is that uterine fibroids interfere with pregnancy or that surgery for fibroids causes infertility. On the 29th, I met with Professor Kim Tae-jung of the Department of Obstetrics and Gynecology at Samsung Seoul Hospital to learn about information and treatment options for uterine fibroids.

 

Why do uterine fibroids develop?

 

Hormones such as estrogen and progesterone, cell growth factors, family history, weight gain, and various other factors interact complexly to increase the risk. Vitamin D deficiency is also a cause. Since the causes are complex and not fully understood, uterine fibroids are also a common condition that is difficult to manage effectively.

 

Sometimes, the size is larger than a year ago during a health checkup. Should I undergo surgery?

 

Having a uterine fibroid does not necessarily mean you need surgery. Treatment can be done when you experience discomfort. Most uterine fibroids are asymptomatic. However, symptoms and discomfort such as heavy menstrual bleeding, abnormal uterine bleeding, pelvic pain, menstrual cramps, pain during intercourse, uterine pressure, and dizziness can occur. If you experience these symptoms, you should not ignore the signals your body is sending and should seek treatment. It is important to monitor the fibroids over time to check for any changes and to assess the symptoms the patient is experiencing. Women with uterine fibroids do not need to have excessive fear.

 

Many people are worried after being diagnosed with a uterine fibroid about 5-6 cm in size while preparing for pregnancy. Does the fibroid interfere with pregnancy?

 

First, most fibroids do not interfere with pregnancy. Just as a baby grows larger during pregnancy, fibroids also grow, and in the later stages of pregnancy, they tend to shrink. After childbirth, fibroids may shrink further or disappear altogether. There are also very small fibroids that cannot be detected through medical imaging devices, and some research suggests that these small fibroids often disappear when the uterus significantly shrinks after childbirth.

 

Additionally, the location of fibroids is important. If the fibroids are on the outer side, they do not affect pregnancy. On the other hand, submucosal fibroids located close to the inner lining, even if small, can interfere with implantation, directly causing infertility or, if pregnancy occurs, triggering early labor. Ovarian cysts, which mainly occur in women in their 20s to 40s along with uterine fibroids, can also cause infertility by inducing surrounding adhesions. Endometriosis, which forms lesions in various locations within the abdomen such as the ovaries or other areas inside the abdominal cavity without resolving menstrual blood within the peritoneal cavity, is also one of the causes of infertility.

 

- Treatment methods for uterine fibroids

 

Fibroids are a condition with many treatment options depending on the situation. Treatment can involve medication or surgery. The scope of surgery varies, including removing only the fibroids, removing the uterus, or preserving the cervix, depending on the patient's condition. For example, a female patient in her late 40s had a 9 cm fibroid. As the fibroid grew, it pressed on the bladder, causing frequent urination. An MRI scan revealed that it was not a simple fibroid but a malignant tumor called uterine sarcoma, which occurs in the uterine muscle or connective tissue. Ultimately, a decision was made to remove the entire uterus.

 

There are many options to choose from, including open surgery that involves cutting the abdomen, laparoscopic surgery that involves making 4 to 5 small holes in the abdomen to insert instruments and remove the lesion, and robotic surgery that removes the lesion through minimal incisions using robotic arms without opening the abdomen.

 

Recently, robot and laparoscopic surgeries are performed more frequently than open surgeries. Single-port robot and laparoscopic surgeries have advantages such as less pain and no visible scars compared to open surgery, significantly reducing the burden. When there are multiple fibroids or the surgery is complex, laparoscopic surgery may not be feasible due to the difficulty of precise procedures. Da Vinci robot surgery is a minimally invasive procedure that removes lesions through minimal incisions without open surgery, using only robotic arms. It typically involves four robotic arms. Both robotic and laparoscopic surgeries have similar operation times, blood loss, and hospitalization periods. However, robotic surgery allows for more delicate procedures compared to laparoscopic surgery, resulting in a higher quality of life for patients.

 

Robotic surgery is also more effective than laparoscopic surgery in preserving and maintaining fertility. According to the 2023 publication of the Journal of Clinical Medicine, an analysis of ovarian function three months after single-port robotic surgery and laparoscopic surgery in patients with ovarian endometriosis showed that the so-called ovarian reserve test, AMH (Anti-Müllerian Hormone), decreased by 24% in single-port robotic surgery and by 34% in single-port laparoscopic surgery. This indicates that single-port robotic surgery minimizes ovarian function decline. From the surgeon's perspective, robotic surgery offers better visualization and easier handling of surgical instruments, resulting in less fatigue and greater convenience compared to conventional laparoscopic surgery.

 

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I had a health checkup a few years ago.

Detailed examination due to uterine fibroids

I requested it, and fortunately, it was a voice message.

Numerous until the test results are available

I thought about it, but I didn't know well because I was ignorant.

Causes and surgical methods of uterine fibroids

I am sharing information because I have it.