{"paper_id":"fe488509-c558-43fc-add2-88c1afbd7999","body_text":"L E T T E R T O T H E E D I T O R Open Access\nTreating symptomatic uterine fibroids with\nmyomectomy: current practice and views\nof UK consultants\nR. Mallick * and F. Odejinmi\nSir,\nWe read with great interest this potentially landmark\nsurvey by Sirkeci and colleagues investigating the atti-\ntudes of UK obstetricians and gynaecologists to the\ntreatment of uterine fibroids [1].\nSuch surveys, as the authors acknowledge, are plagued\nby low response rates; however, they can also be subject to\nsignificant recall bias and furthermore those who respond\nto such questionnaires tend to have an interest in the sub-\nject matter. It is therefore surprising to find that a third of\nthose who responded would still not set a limit to the\nnumber of fibroids removed hysteroscopically. There is in-\ncreasing evidence that submucous fibroids greater than\n4 cm, especially when there are multiple types of fibroids\npresent, should be removed laparoscopically as hystero-\nscopic resection does not allow complete removal and in-\ncreases the risk of recurrence [2]. Furthermore, only 43%\nof respondents who perform open myomectomies would\naim to remove all fibroids, resulting in an increased risk of\nrecurrence and the need for secondary intervention, which\nis known to be significantly less successful than primary\ninterventions particularly with regard to fertility and\nsymptom resolution [3].\nMost of the respondents agreed that the more com-\nplex operations should be performed by those with more\nexperience; however, conversely, those with more experi-\nence were least likely to perform a laparoscopic myo-\nmectomy, which in 2017 should be considered the “gold\nstandard” surgical treatment.\nIt is good to see that the numbers of gynaecologists in\nthe UK performing myomectomies have increased since\nthe previous survey over a decade ago; however, these\nnumbers still remain small. Furthermore, disappoint-\ningly, almost 40% of women still do have access to facil-\nities offering uterine artery embolisation.\nWith regard to perimenopausal women, the number of\nrespondents who would perform myomectomy in this co-\nhort has increased. However, a large proportion of women\nare still deprived of this uterine sparing option by a con-\nsiderable number of gynaecologists despite existing evi-\ndence to show that myomectomy is as safe in the older\nwoman once the issues surrounding leiomyosarcoma are\ninvestigated and discussed [4]. Although myomectomy\nwould not be the first-line treatment of choice for women\nin this age group, many patients do wish to conserve their\nuterus and they should be given adequate information and\ncounselling to allow them to make an informed choice.\nFinally, with the changing face of the gynaecological\nworkforce in the UK as reiterated by this survey, though\nthe authors advise caution in the interpretation of the re-\nsults, it sends a clear message of disparity in the availabil-\nity of the various different treatment modalities for\nfibroids. It is thus important that we re-evaluate the man-\nagement options for such women and perhaps consider\nsetting up specialised tertiary referral centres to allow all\nwomen access to experienced surgeons who would take a\nholistic multidisciplinary approach to management and\nhave access to all the various treatment modalities in line\nwith what is readily available to women with endometri-\nosis via the “BSGE badged” endometriosis centres.\nAcknowledgements\nNothing to declare.\nFunding\nNot applicable.\nAvailability of data and materials\nNot applicable.\nAuthors’ contributions\nRM and FO both participated in the manuscript writing, and both authors\napproved the final manuscript.\nAuthors’ information\nNothing to declare.\n* Correspondence: rmallick@doctors.org.uk\nDepartment of Gynaecology, Barts Health NHS Trust, Whipps Cross University\nHospital, London E11 1NR, UK\nGynecological Surgery\n© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0\nInternational License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and\nreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to\nthe Creative Commons license, and indicate if changes were made.\nMallick and Odejinmi Gynecological Surgery  (2017) 14:28 \nDOI 10.1186/s10397-017-1033-1\n\nEthics approval and consent to participate\nNot required.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare that they have no competing interests.\nPublisher’sN o t e\nSpringer Nature remains neutral with regard to jurisdictional claims in\npublished maps and institutional affiliations.\nReceived: 17 July 2017 Accepted: 10 December 2017\n/\nReferences\n1. Sirkeci RF, Belli AM, Manyonda IT (2017) Treating symptomatic uterine\nfibroids with myomectomy: current practice and views of UK consultants.\nGynecol Surg 14(1):11\n2. Wang CJ, HT Y, PJ W, Su H, KY W, Han CM (2013) Laparoscopic\nmyomectomy instead of hysteroscopic myomectomy for large submucous\nfibroids. Gynecol Minim Invasive Ther 2(3):93– 95\n3. Frederick J, Hardie M, Reid M, Fletcher H, Wynter S, Frederick C (2002)\nOperative morbidity and reproductive outcome in secondary myomectomy:\na prospective cohort study. Hum Reprod 17(11):2967 –2971\n4. Odejinmi F, Maclaran K, Agarwal N (2015) Laparoscopic treatment of uterine\nfibroids: a comparison of peri-operative outcomes in laparoscopic\nhysterectomy and myomectomy. Arch Gynecol Obstet 291(3):579 –584\nMallick and Odejinmi Gynecological Surgery  (2017) 14:28 Page 2 of 2","source_license":"CC-BY-4.0","license_restricted":false}