New surgery could help avoid hysterectomies

BOLOGNA, Italy - A Dutch doctor has developed a new method of uterine surgery that early tests indicate is safer and simpler than the current one and could avoid thousands of hysterectomies.

The method commonly used to cut out non-cancerous growths, resectoscopy, carries the risk of dangerous side effects, including swelling of the brain and death. Concern over the complications prompts many doctors to remove the whole uterus.

The new technique, which cuts tissue with a rotating blade encased in a wand, then sucks it up a tube, has been tested on 30 women and safely and easily solved their problems while leaving their fertility intact.

The method was presented Monday at the European Society of Human Reproduction and Embryology.

Its developer, Dr. Mark Emanuel from Spaarne Hospital in Haarlem, the Netherlands, said the technique would help women whose growths - fibroids or polyps - are on the inside surface of the womb in a place that is accessible to an instrument inserted through the cervix.

That would amount to about 25 percent of women with fibroids, the more common type of growth. Polyps are classed together with other menstrual problems, so the population of women that could be helped was not immediately available.

Fibroids are formed from cells in the uterine muscle, while polyps are made of cells from the lining. They can cause debilitating symptoms, including heavy bleeding and painful cramps, miscarriage and other fertility problems.

About 670,000 hysterectomies are performed each year in the United States, about a third for fibroids.

''Many of my colleagues fear the resectoscopy. They think it's too difficult,'' Emanuel said of the technique, which uses a wire loop electrode to cut out the growths.

At least two other alternatives have been developed but they are either too slow or vaporize the growths, leaving no tissue to examine. And they both use electric currents, which could go through the wall of the uterus and damage organs such as the bladder, said Dr. Elizabeth Stewart, clinical director of the Center for Uterine Fibroids at Brigham and Women's Hospital in Boston.

The method used varies greatly across different areas, she said. In most large hospitals, women are offered some kind of alternative to hysterectomy. But while the electric wire approach requires special training, all gynecologists know how to perform a hysterectomy, she said.

''This sounds like a new option. We'd like to get faster and easier treatment with these (growths),'' said Stewart, who was not connected with the Dutch work. ''It sounds as though it may be easier. The innovation with this is it doesn't use electricity.''

A major problem with resectoscopy is that because it uses an electric wire to cut the tissue, the uterus must be inflated with a liquid that does not conduct electricity so that the electrical current stays focused on the tumor.

Such fluids contain no salt, which is essential to the body but conducts electricity. The liquid used in resectoscopy dilutes the blood's salt concentration, which can lead to swelling of the lungs and brain cells, seizures and sometimes death.

Doctors can give the women salt to restore the balance, but the right amount is difficult to measure during the operation.

Emanuel's method uses saline solution to inflate the womb.

''For the average gynecologist, it's a technique that makes it easier to remove uterine tissue,'' Emanuel said.