Sonalleve MRI guided High Intensity Focused Ultrasound
MRI guided HIFU, or Magnetic Resonance Imaging guided High Intensity Focused
Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do not require any treatment for these fibroids. Occasionally, the fibroids can cause pain, heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of micturition due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.
Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.
As fibroids are almost always benign, with a negligible percentage (0.07% of operated patients – Parker W, Berek J, Fu YS., Obstetrics and Gynaecology 1994; 83:414-8) showing the presence of a sarcoma (malignancy), fibroids only require treatment for the alleviation of symptoms due to the fibroid.
Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.
The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anaesthesia remain a constant threat.
The search for non-invasive techniques to provide the patient with relief from this otherwise non-threatening illness led to other minimally invasive options like Uterine Artery Embolization, and Radio-Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.
MRI guided HIFU, or Magnetic Resonance Imaging guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.
The procedure is gaining wide acceptance because of the ease of use, exemplary safety and minimal disruption in the patients’ daily routine. This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure.
The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term (Elizabeth A Stewart et al, Obstet Gynecol 2007; 110:279-87).