One of my favorite professors in medical school was fond of saying “There is nothing so constant in medicine as variation.” From my perspective, more than 25 years in clinical medicine, there is nothing so constant in medicine as change. At times the rate at which this change goes on is quite amazing. This can especially be said for the treatment of uterine fibroids over the last 100 years.
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The most dramatic change in fibroid treatment occurred as a consequence of the evolution of surgical techniques. Historically surgery was a very dangerous undertaking from which many did not survive. Now surgery is commonplace and easy at least for the surgeon. In fact, it has become so easy that it has leant itself to excess use.
The term ‘elective surgery’ which did not exist prior to the 20th century is now used to describe the majority of gynecologic surgery. In essence, this term refers to the fact that a procedure is not being performed to save a person’s life. Certainly this is justifiable when the quality of life is being improved or future foreseeable threats can be made avoidable. But when major surgery is performed in the absence of either symptoms or foreseeable future threat to well-being justification is wanting.
Hysterectomy for fibroids has become so common that it has become synonymous with fibroids in the minds of some. No matter how easy and safe major surgery has become, to be cut open has never been a life’s goal any sane individual. Thus, at the same time that surgery was becoming more commonplace, methods to minimalize or avoid it have evolved. Thus we have seen laparoscopy used increasingly to eliminate the need for large incisions in major surgery to reduce complications and shorten recuperation time.