LITT for treating large fibroids ANYBODY KNOWS WHERE TO GET?

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Laser-induced interstitial thermotherapy (LITT) for treatment of uterine leiomyomas: 750 myomas were treated by LITT and the results over a five-year period are analyzed
Chapman, Roxana

Approximately 750 leiomyomas of 250 symptomatic patients were treated by LITT over a five-year period. Only 12% were lost to follow-up. Most were treated by a combination of the KTP/YAG laser, rarely by one or the other alone, and a few with the diode laser. The fiber optic was inserted 2 cm apart and, depending on the size of the tumor, 480 - 20,000 Joules were required. Most were treated laparoscopically but very large myomas were treated percutaneously under ultrasound control. Symptoms were nearly always relieved and the six failures were found to be due to unrecognized adenomyosis and other associated pathology. Half the patients complaining of infertility became pregnant and, in those whose only pathology had been leiomyomas it approached 90%. Vaginal delivery was not found to be contraindicated. Finally, oestrogen receptors and epidermal growth factor were found to be destroyed. It is concluded that LITT enables leiomyomas of all sizes and locations to be treated by a minimally invasive method with preservation of the uterus.
561 Percutaneous laser-induced interstitial thermotherapy (LITT) for the treatment of very large uterine leiomyomas
Chapman, Roxana

The success of treating tumors of the liver under local anaesthesia and ultrasound and computered tomography control by mens of the diode laser of 810 nm wavelength with fiber splitter and multiple fibers suggested this form of LITT might be suitable for the treatment of very large leiomyomas where laparoscopy was not possible. The immediate effect of LITT was to produce a large volume of coagulation within the myomas, to destroy the oestrogen receptors and to coagulate the surrounding blood vessels. After one month the coagulated volume had been converted into a jelly-like substance and the zone surrounding this had started to degenerate because of the destruction of its blood vessels which had resulted in local tissue anoxia. Three months later the central coagulum and surrounding zone had been partially absorbed and the whole volume of myoma treated had shrunk to a quarter of the original size. It has thus been shown that a minimally invasive method for the destruction of very large uterine leiomyomas can be safely performed, but further research is required before its general adoption.
554 Laser-induced interstitial thermotherapy (LITT) with the KTP 532 laser for the treatment of uterine adenomyosis
Chapman, Roxana; Chapman, Kenneth

Adenomyosis is a condition in which the myometrium is infiltrated by endometrial glands and stroma. This results in myometrial hyperplasia, uterine enlargement and causes menorrhagia, dysmenorrhoea and dyspareunia for which there is no known cure other than hysterectomy. The success of LITT in the treatment of uterine leiomyomata suggested that this might also be effective for the treatment of adenomyosis. Initially LITT was carried out on patients with adenomyosis prior to hysterectomy, then on patients who had completed child-bearing and finally on those who desired a family. Not only were symptoms relieved but pregnancies occurred spontaneously. The KTP 532 nm component of the KTP/YAG laser, which is absorbed by red pigment, was used with a 600 micrometer fiber with a bare tip via a needle microstat at laparoscopy. Holes were drilled in the abnormal tissue 3 cm apart and the laser fiber then slowly withdrawn, the object being to coagulate the surrounding blood vessels and adenomyotic tissue. The number of joules required depended on the volume of tissue treated