Non-invasive Uterine Myomectomy

HIFU Becomes a New Option

Department of Obstetrics and Gynecology,  China Medical University Hospital

Dr. Tyson Tai-Fu Chou

Ms. Chang (not the patient's real name) is a young woman in her 30s. She is planning her wedding and getting ready for the next stage of her life. She hopes to get pregnant soon but is concerned about scarring as a result of uterine surgery and the six+ months recovery period required since she was found to have a few uterine myoma in the past. She was concerned this may have an impact on her future plans. Therefore, she visited China Medical University Hospital and consulted a doctor at the Division of Obstetrics and Gynecology to discuss related treatment approaches for uterine myoma. After a few consultations and discussions from many different aspects, she chose HIFU and was discharged the day after the procedure.

Dr. Tyson Tai-Fu Chou said that uterine myoma is quite a common benign disease among women. On average, one in three or four women experience uterine myoma in Taiwan. As uterine myoma formation is closely related to hormones in the body, it is expected that uterine myoma will continue to grow every year in the woman before menopause. More than 98% of uterine myoma are benign. Very few are a malignant uterine sarcoma. Most uterine myoma are asymptomatic so the woman may not even be aware they have uterine myoma. However, as per the different locations and sizes of myoma, many different signs and symptoms can occur, including anemia induced by menorrhagia, abdominal distention, frequent micturition, infertility or recurrent miscarriages, which often cause stress and disturbance to the patient's everyday life.

Traditional approaches for uterine myoma management include follow-up consultations and observation, medication for symptom relief, or surgery.  Surgery options include traditional open abdominal surgery, minimally invasive laparoscopy and the da Vinci System for Surgery; none of these operations require intubation, general anesthesia or post-surgery wound care support. Therefore, patients need to be hospitalized for observation. However, the HIFU procedure can provide the patient with an alternative to surgery, not only removing the risk of anesthesia but also avoiding post-surgery wounds and the need for hospitalization. All these advantages make HIFU significantly different from traditional treatment approaches.

“HIFU”is a kind of high intensity focused ultrasound that uses the ultrasound as energy by transforming the energy of sound into heat, then the extrinsic high intensity ultrasound applies its penetrating and focusing characteristics to project on to the loci in the body. By way of the heat effect, the temperature of the tissue at the loci will immediately increase from 65 to 100℃ so the protein is denatured, and the tissue cell becomes coagulative necrosis. The interstitial fluid, intercellular fluid and gas molecules in the cells then form bubbles under the ultrasound effect, and after repeated contractions and expansions the cells of the loci become damaged. The necrotic cavitation and mechanical effect destroy the blood supply to obtain the desired results.

Dr. Tyson Tai-Fu Chou mentioned that the advantages of HIFU include the fact that it is a non-invasive procedure, there's no bleeding as it preserves the intact uterine without wound, no anesthesia is required and no normal tissue injury occurs. The treatment approach has been improved to be implemented while the patient is lying down, and no anesthesia is required, unlike previously when it was used as part of the procedure. The most important thing is that the treatment can be repeated, so the patient can continue treatment should the loci return, the myoma recurs or a new myoma develops. Patients can get the treatment early in their diagnosis as they don't need to wait until the tumors are large enough for surgery or a hysterectomy.  

Although uterine myoma is a kind of benign disease, HIFU provides another option for patients who wish to retain the uterine. It may be not be suitable for all uterine myoma patients so please discuss with your doctor carefully and follow related examinations as required before following this approach. If you have any questions about HIFU treatment, please consult the doctor of Obstetrics and Gynecology for further information.