Name of the Procedure:

Focused Ultrasound Ablation of Uterine Leiomyomata with MR Guidance; Total Leiomyomata Volume Greater or Equal to 200 cc of Tissue

Summary

Focused ultrasound ablation of uterine leiomyomata, also known as focused ultrasound surgery or MRI-guided focused ultrasound, is a non-invasive procedure that uses high-intensity ultrasound waves to target and destroy fibroids (benign uterine tumors). The procedure is carried out with the assistance of magnetic resonance imaging (MRI) to precisely locate and monitor the fibroids during treatment.

Purpose

This procedure addresses uterine fibroids (leiomyomata) that are causing symptoms such as heavy menstrual bleeding, pelvic pain, or pressure. The primary goal is to shrink or eliminate the fibroids, thereby alleviating symptoms and improving quality of life.

Indications

• Symptomatic uterine fibroids causing heavy menstrual bleeding, pelvic pain, or pressure.
• Patients with a total leiomyomata volume greater or equal to 200 cc of tissue.
• Women who seek a non-invasive alternative to traditional surgical treatments such as hysterectomy or myomectomy.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Pre-procedure imaging tests, such as an MRI, to locate and assess the fibroids.
• Review of current medications, with potential adjustments as advised by the physician.

Procedure Description

1. The patient lies on the MRI table, and the lower abdominal area is positioned over the ultrasound transducer.
2. MRI scans are taken to pinpoint the exact location of the fibroids.
3. High-intensity focused ultrasound waves are directed at the fibroid, heating and destroying the tissue.
4. Continuous MRI imaging is performed throughout the procedure to ensure precision and effectiveness.
5. The procedure is typically done under mild sedation and local anesthesia to minimize discomfort.

Duration

The procedure usually takes between 3 to 4 hours, depending on the size and number of fibroids being treated.

Setting

Focused ultrasound ablation is performed in a hospital or an outpatient clinic equipped with MRI technology.

Personnel

• Radiologist or interventional radiologist
• MRI technician
• Nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Skin burns over the treated area
• Temporary pain or discomfort
• Nausea or vomiting post-procedure
• Rarely, injury to adjacent organs or tissues
• Incomplete treatment of fibroids resulting in the need for additional procedures

Benefits

• Non-invasive, avoiding surgical risks and scars
• Shorter recovery time compared to surgery
• Immediate symptom relief typically noticeable within a few weeks
• Preservation of the uterus, maintaining fertility in many cases

Recovery

• Most patients can return to normal activities within a few days.
• Mild pain or discomfort is usually managed with over-the-counter pain relievers.
• Follow-up MRI within 3-6 months to assess the treatment's effectiveness and fibroid size reduction.

Alternatives

• Medications to manage symptoms (e.g., hormonal treatments)
• Uterine artery embolization (UAE)
• Myomectomy (surgical removal of fibroids)
• Hysterectomy (surgical removal of the uterus)
• Pros of alternatives: Depending on the option, more immediate fibroid removal.
• Cons of alternatives: Invasive nature, longer recovery times, and potential loss of fertility (in the case of hysterectomy).

Patient Experience

During the procedure, patients may feel warmth or slight discomfort in the treated area. Mild sedation and local anesthesia help with pain management. Post-procedure, some cramping or mild abdominal pain is common but usually subsides within a few days. Overall, the experience is generally well-tolerated with a quick return to everyday activities.