Q: A relative of mine needs an operation for fibroid tumors. She has been in twice for the operation, but they can't intubate. Is there any way to have the operation without intubation? Can a spinal work?
-- P.S., Tonawanda
A: First, with respect to your relative's difficulty undergoing general anesthesia, I suggest she try to find out why she couldn't be intubated. This may require seeing a specialist like an anesthesiologist.
However, she may have some alternatives to general anesthesiology for fibroid surgery. Let me explain.
Fibroid tumors are noncancerous growths in the muscular wall of the uterus. They are usually round, firm and composed of smooth muscle and connective tissue. They are the most common noncancerous tumors of the female genital tract, occurring in a third of all women over 35. They are more common in African-American women.
Often, multiple fibroids are present, and they can range in size from microscopic to as large as a cantaloupe. The cause is unknown, but is related to estrogen levels.
Fibroids often produce no symptoms. When symptoms do show up, they can include menstrual irregularities such as heavy and irregular bleeding and painful menstruation; anemia can be a problem because of excessive blood loss.
Abdominal swelling, pelvic pain, urinary frequency and constipation may be seen if the tumors become large enough to press against other organs. The presence of fibroid tumors can cause some serious problems during pregnancy, including abortion, premature or obstructed labor and hemorrhage.
There are several treatment options, including doing nothing.
Nonsymptomatic fibroids often require no treatment, but regular checkups are suggested to check on growth or other changes in the fibroids.
Drug treatment should be considered before surgery. Synthetic gonadotropin-releasing hormone (GnRH) analogs inhibit estrogen production and reduce fibroid size.
However, long-term estrogen suppression has side effects and GnRH-like drugs are expensive and can't be taken orally. These drugs are often used as pretreatment to reduce fibroids before surgery, however.
Standard surgery is either a myomectomy (the surgical removal of the tumors only), or total or partial hysterectomy. Myomectomy may preserve the uterus for women who think they may want to have children, but excessive bleeding may occur afterward.
A review of the literature revealed several new alternatives to these standard surgical procedures that don't require general anesthesia. One such alternative procedure is called the OPERA procedure and involves inserting an instrument directly into the uterus through the vagina.
This procedure removes just the fibroids and part of the uterine lining, and is done under local anesthesia in about an hour, often with no overnight hospital stay.
Another new alternative recently approved by the FDA is called the "balloon" technique. It uses a heated liquid in a latex balloon to ablate (remove) the lining of the uterus and prevent bleeding. It takes approximately 30 minutes.
Ablation by more well-known electrosurgical procedures can be performed with an epidural or spinal anesthetic.
A new nonsurgical procedure that is still in the experimental stage is called uterine artery embolization. In this procedure, tiny particles of plastic are injected directly into the arteries that feed the tumors.
The particles form clots that block the arteries and cut off the blood supply to the tumors. When that happens, oxygen and nutrients are cut off and the tumor tissue degenerates and is reduced to simpler chemicals that can be removed by the body.
Finally, a recent research report described an experimental procedure called cryomyolysis, which is simply the freezing of affected uterine tissues. This procedure is also called cryoablation.
This may be an incomplete list -- there may be other procedures I'm not familiar with. In any event, if your relative's intubation problem cannot be resolved, she should return to her gynecologist to find out more about these newer procedures, and the risks and benefits of each as they relate to her individual situation.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.
This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.