What is Radio Frequency Ablation?

This technology, whether CT or MR guided, is similar to doing a myolysis except you don't do a laparoscopy.  High Frequency Focused Ultrasound ("HIFU") is also being studied for this application.

These procedures have very limited applications.  They can only treat fibroids in specific portions of the uterus and of specific size ranges.  Like all local therapy that only treats a small portion of a patient's fibroid burden, they will also inevitably be shown to have recurrence rates similar to (if not higher than) myomectomy.

When I was in England for a meeting a few years ago there was a very elegant presentation on MR guided fibroid ablation.  The doctor was very happy with her results, until another doctor commented that more than half of her patients had later come to him for UAE so that the rest of their fibroids could be treated.  - Robert Worthington-Kirsch, M.D.

What is MRI-Guided Focused Ultrasound Surgery (FUS) for leiomyoma (fibroids) of the uterus?   

MRI-Guided Focused Ultrasound Surgery (FUS) is a non-invasive thermal ablation, and is another method of myolysis.  As with any medical procedure, the procedure is not without risks. The EXTREMELY expensive equipment to perform the surgery may cause the procedure not to be widely available.  

The FDA approval process for FUS is projected sometime in 2004. The first study was performed on women who were pre-menopausal or who had completed their families. The long-term results or effects of FUS are still not known.  

At this time, it appears the procedure is practical for women who only have a few fibroids (1-5 fibroids).  Women who have multiple (10- 20 fibroids) fibroids may not be good candidates for the procedure due to the time to treat the fibroids would be prohibitive.  As the procedure develops, it may be a useful treatment to alleviate symptoms caused by specific fibroids (rather than a global treatment for all fibroids present). 

Before the surgery, the woman will receive a light sedation.  The patient lies on her stomach on a treatment bed, and is moved inside an MRI image system.  The doctor acquires a set of anatomic images, which identify a target volume of tissue to be treated, and draws the treatment contours.  A small ‘bean’ shaped volume of focused ultrasound energy is directed into the target, heats the fibroid tissue, and kills the tissue. The treatment takes approximately 2-4 hours.  The patient stays in the hospital for several hours after the procedure and then is released to go home.  Most women can resume their normal activities within 24 hours. 

The clinical trials are being performed in specific hospitals in the United States:  Boston, Baltimore, and Rochester, Minnesota.  The treatment is available in Europe.  There are sites in London England, Budapest, Berlin, Jerusalem, Tel Aviv, and Japan.  Refer to ‘Research’.

2006:  ExAblate (MRgFUS) - article

What is the Laparoscopic Fibroid Tx Clips uterine arteries procedure?  Who performs this procedure and are their specific medical skills that are needed to do this procedure?  What are the pros and cons for this procedure?  How long has this procedure been around?  What is the success rate?

Uterine artery occlusion is an attempt to cut off the blood supply to fibroids and cause shrinkage.  Very preliminary studies suggest it may have similar results to UFE, but it's too early to say.  There is less pain afterwards, but it is difficult to do, and I think will have a high complication rate in unskilled hands. – Paul Indman, M.D.

The guiding principle of embolotherapy is to get the embolizant material distal - into the small vessels near the tissue to be affected. Laparoscopic ligation of the Uterine Arteries results in proximal occlusion of the vessels. I have seen several women who have had one Uterine Artery ligated at previous surgery and have developed collateral flow around the point of ligation. 

Consider this analogy. If you picture the fibroids as residents of a suburb and the blood supply as the road system, UAE sets up roadblocks at the entrance to the street where the fibroid live, preventing access. Uterine Artery ligation sets up roadblocks on one exit of the interstate leading into the suburb, but there are always lots of available 'short-cuts' to get around the roadblock (including getting off at the next exit, which would be supply to the uterus through the Ovarian Artery). – Robert Worthington-Kirsch, M.D.

NOTE:  This procedure is performed by some Gynecologists.  The laparoscopic approach requires a skilled Laparoscopist.  It is always good to research the doctor's training, expertise, and success rate before deciding on a uterine fibroid procedure. 

What are adhesions?  Will adhesions prevent a woman from having the option of deciding on a hysterectomy alternative to treat her uterine fibroids (examples: Myomectomy and UAE)?

Adhesions occur when the outer surfaces of the organs in the belly get inflamed and stick together, forming bands of tissue that hold them together.  UAE does not treat adhesions. UAE may be less likely to cause adhesions than surgery such as myomectomy, but this has not been thoroughly studied. – Robert Worthington-Kirsch, M.D.

The diagnosis of adhesions can only positively be made at surgery.  The presence of adhesions will not usually influence how fibroids are treated. – Paul Indman, M.D.        

If a woman has a C-Section years ago and now has uterine fibroid symptoms that need treated, will the C-Section make it impossible for a woman to have a Myomectomy or UAE performed? 

Shouldn't make any difference. - Paul Indman, M.D.  

I had an Abdominal Myomectomy and my recovery time (with a lot of pain) was 8 weeks.  I also had to have a c-section when I delivered my child and my recovery was 6 weeks.  Is my uterus weak from the Myomectomy?    

First of all, everybody recovers at different rates, but 8 weeks to recover from a myomectomy and 6 weeks for a cesarean is much longer than I usually see with my patients.  It is very unusual for someone to have pain that isn't easily controlled with medication.

Once someone has had a cesarean birth, it used to be recommended that all future deliveries also be by cesarean, because of the small risk of rupture of the uterus.  Over the last several decades more women are having vaginal births after cesarean (VBAC) but the pendulum is swinging back.  If a myoma removed goes deep into the uterus, there is also a small risk of uterine rupture.  The exact numbers are unknown, but are low.  Nevertheless, most women choose not to take the risk and have a cesarean.  If fibroids removed are more superficial most obstetricians will allow a women to labor. - Paul D. Indman, M.D.

Can a C-Section cause a woman to go into early menopause after a hysterectomy alternative treatment?

Menopause can occur at any age after 35. There is evidence that women 45 and older may never have a period after UAE (15-20% of the time), and about half of these develop menopausal symptoms. 

The C-Section probably has little to do with it one way or the other. These symptoms can normally occur for several years before women finally stop having periods.- Robert Worthington-Kirsch, M.D.

Myomectomy shouldn't make any difference on the risk of premature menopause. - Paul D. Indman, M.D.