Many women suffer from fibroids – up to fifty per cent. The figures quoted by experts vary widely because many women are unaware they have fibroids. Fibroids are benign tumors in the muscular layer of the uterus; in other words, they are growths which, depending on their location and size, can cause quite severe symptoms. Dr Garri Tchartchian is an experienced consultant and an absolute specialist in minimally invasive fibroid treatment: as head of the Fibroid Center at the Clinic for Minimally Invasive Surgery (MIC) in Berlin, he performs the highest number of fibroid procedures in Germany. Year after year, this amounts to around a thousand minimally invasive operations – an impressive figure! Dr Tchartchian has also published numerous scientific papers on the subject and developed a special surgical technique named after him: the ‘Change over according to Tchartchian’ method. We spoke to the fibroid specialist about modern treatment for this condition.
Leading Medicine Guide: Many women are affected by fibroids. When is treatment necessary?
Dr Garri Tchartchian: 99.94 per cent of fibroids are benign tumors in the muscular wall of the uterus. In most cases, fibroids do not cause any symptoms. However, depending on their location and size, medical intervention may be required. There are fibroids that are so poorly situated that we take action even when they are just one to two centimeters in size. Others we can continue to monitor even when they are six to eight centimeters in size. However, if the fibroids cause heavy bleeding or if there is a desire to conceive, then we intervene medically.
Leading Medicine Guide: Are there any other methods besides surgical treatment?
Dr Garri Tchartchian: Yes, we have conservative alternatives available. The first is embolisation – the occlusion of the blood vessels. However, this method has the disadvantage that it can cause severe pain. The second option is MRgFUS treatment: this is a magnetic resonance-guided, focused ultrasound treatment. In this procedure, the fibroid is treated with ultrasound waves, causing it to shrink. This method does not cause pain, but the fibroids can regrow after a year. And we do not recommend this method if you still wish to have children. The third method is hormonal therapy with Esmya. There have been serious complications in the past, which is why we do not use this method at the MIC.
Leading Medicine Guide: You are a specialist in minimally invasive surgery for fibroids throughout Germany. There is even a surgical method named after you!
Dr Garri Tchartchian: At MIC Berlin, we perform around 1,500 fibroid procedures annually; I personally carry out about a thousand. As a result, I now have many years of experience in this field and have continuously improved and refined my own surgical techniques over time. 99.7 per cent of the fibroid operations we perform at MIC Berlin are minimally invasive procedures. We can even operate on large fibroids using the ‘Change over according to Tchartchian’ method – that is the name of the procedure, which is now also used internationally. The uterus with the fibroid, which we operated on using a minimally invasive technique without complications, weighed over 4065 grams.
Leading Medicine Guide: We have done our homework: fibroids develop in the muscular layer of the uterus. So they cannot simply be cut away. Could you explain the procedure to us in more detail?
Dr Garri Tchartchian: Depending on the location of the fibroid, surgery can be performed via the vagina. However, most fibroids are treated using minimally invasive techniques. We call this ‘plastic uterine reconstruction’ (PUR), as it takes into account the specific characteristics of the uterine muscle layers – particularly in the case of patients wishing to have children. The surgical site is accessed via two small incisions in the lower abdomen and one incision in the navel. The uterus is then opened layer by layer and the fibroid exposed. The uterine layers are preserved as much as possible and remain intact. The layers are sutured one by one using absorbable material, which dissolves after a certain period of time.
Leading Medicine Guide: So patients can still become pregnant after this procedure, can’t they?
Dr Garri Tchartchian: With our procedure, the supporting, functional layers of the uterus that are important for pregnancy are damaged as little as possible. The scars are kept very small, so that the uterine wall is certainly capable of withstanding the strain of pregnancy. If we were to check the surgical area again via laparoscopy around six months after the procedure, the treated areas would be virtually invisible.
Leading Medicine Guide: Couldn’t women still have a baby despite having a fibroid?
Dr Garri Tchartchian: This carries various risks: fibroids can cause bleeding, trigger premature contractions and lead to premature birth or miscarriage. We recommend that patients with fibroids contact us so that we can discuss all possible treatment options together.
Leading Medicine Guide: If a patient is diagnosed with a fibroid, what should she do? Is it best to simply go to the nearest hospital, or should she contact a specialist center?
Dr Garri Tchartchian: I strongly advise going to a specialist center, as that is where the most experience lies. Every center in Germany has its own specialization. Our fibroid center specializes in minimally invasive procedures for fibroids.
Leading Medicine Guide: Can patients with statutory health insurance also come to you at MIC Berlin?
Dr Garri Tchartchian: Of course, we accept all health insurance schemes and we have dedicated consultation hours for difficult cases. We can also be consulted for a second opinion on a diagnosis and treatment plan – a ‘second opinion’, in other words. This means we receive many patients from outside the region. This includes around 400 patients a year who were offered an open abdominal incision – but whom we are then able to treat using minimally invasive techniques. A large horizontal incision across the lower abdomen or a large vertical incision causes significant damage to the abdominal wall and is extremely taxing. With our small incisions, the risk of adhesions is significantly reduced; patients experience less pain, recover more quickly, not to mention the cosmetic benefits.
Leading Medicine Guide: In the past, the entire uterus was often removed during myoma surgery. What is your view on this?
Dr Garri Tchartchian: Fortunately, those days are over for us. I believe that a woman’s wish to keep her uterus, even in later life, should be treated with the utmost respect. We were the first to perform organ-preserving surgery even in cases of large fibroids and in older patients. This leaves the pelvic floor and genital area intact, and women recover more quickly.
Dr Tchartchian, thank you for the interesting interview!
What is a fibroid?
Fibroids are benign tumors that can form in the muscular layer of the uterus. They usually go unnoticed. It is only when they cause symptoms such as heavy bleeding or permanent infertility that they are noticed. Through a physical examination and ultrasound, the doctor can determine their location and size. Fibroids can only be properly removed through surgery. The risk of recurrence is around fifteen per cent.
Uterine fibroids: decision-making guides
If you have been diagnosed with a fibroid and are unsure what decision to make regarding your treatment, this page may be of help:
You can contact Dr Tchartchian directly via his profile page.
Image sources: nerudol, Erica Smit, Tierney – Adobe Stock.
