Ablacja mnogich mięśniaków macicy za pomocą EchoLasera® – opis przypadku

Przedstawiamy poniżej opis przypadku ablacji mnogich mięśniaków macicy za pomoca EchoLasera@ opracownay przez dr n. med. Tomasza Sędziaka.

Introduction
Uterine leiomyomas are common benign tumors of the female genital tract, found in nearly every fourth woman of reproductive age [1]. While leiomyomas are mostly asymptomatic, some
may produce various clinical symptoms, such as abnormal menstrual bleeding, pelvic pressure symptoms or pain, infertility and obstetric complications [2]. Currently, the most suitable surgical
option for women with uterine leiomyomas, who want to retain their fertility, is myomectomy, whether hysteroscopic, laparoscopic or open. However, myomectomy is a relatively extensive
procedure which poses a risk of various complications (uterine rupture, bleeding, incomplete resection, etc.) and its effects on reproductive function remain controversial.

EchoLaser® is a new device for ultrasound-guided micro-invasive treatments. This is the first and only laser system integrated with a navigation, planning and simulation system. EchoLaser®
consists of an ultrasound probe and a multi-source laser (up to 4 sources); thanks to the incorporation of the ultrasound, the device can be used for both identification of the lesions and
real-time monitoring of the correct positioning of laser fibers and the actual extent of the damage caused to the lesion.
Below, we present the case of a patient with multiple uterine leiomyomas ablated with EchoLaser®. To the best of our knowledge, this is the first published report documenting the
successful application of EchoLaser® in this indication.

Case report
A 42-year-old premenopausal woman was referred to the clinic on 30 November 2019, with multiple uterine leiomyomas found on ultrasound by a local practitioner. The patient complained
about a recurrent pelvic pain without vaginal bleeding. A screening test for cervical cancer performed eight months earlier showed no abnormalities. Ultrasound examination carried out on
admission revealed two intramural uterine leiomyomas with an overall size of 75 mm x 56 mm x 56 mm. Because the patient did not exclude further reproductive plans and based on the clinical and
ultrasonographic presentation of the lesion, the woman was qualified for EchoLaser® ablation.

The procedure was carried out on 18 December 2019 at EMC Clinic in Wroclaw (Poland). After the introduction of spinal anesthesia with bupivacaine hydrochloride (Maracain Heavy 0.5%, 4
ml), the two leiomyomas were localized by the operator (Dr. Tomasz Sędziak) under ultrasound guidance and ablated with two long fibers of EchoLaser® (1,600 J each). The entire procedure lasted
30 minutes. Neither bleeding nor other periprocedural complications were recorded.

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