Interstitial laser photocoagulation of uterine leimyoma

Uterine leiomyomas (fibroids) are common benign tumors which may cause heavy or painful periods, may present as a pelvic mass and are associated with infertility. Local excision of symptomatic lesions can be difficult and hazardous, and the alternative is hysterectomy. We are investigating interstitial laser photocoagulation (ILP) as a less invasive alternative. Initial experiments were undertaken on 40 fibroids after surgical removal. One or two bare tipped, precharred fibers from a 25 W semiconductor laser (805 nm) were inserted into the center of the fibroid and treatment delivered with 2 - 10 W for 100 - 1000 sec. Specimens were subsequently sectioned perpendicular to the fiber track. Fibroids are very pale and apart from occasional charred tracts there was little evidence of thermal coagulation macroscopically or after haematoxylon and eosin staining. However, using a diaphorase stain technique we were able to demonstrate ellipsoid zones of devitalized tissue up to 20 mm across (15 mm for single fibers). These results suggest that ILP is producing gentle, uniform coagulation which could lead to resorption of treated areas. With appropriate numbers of treatment sites, this could permit minimally invasive management of clinically significant lesions. Clinical studies have commenced treating fibroids with ILP at the time of surgical excision by myomectomy or hysterectomy.