Heavy bleeding, cramping, infertility, pelvic pain. Fibroids can cause all of these symptoms and more and represent a significant burden on the women who suffer from them. In fact, treatment for fibroids is the number one reason women aged 35 to 54 undergo a hysterectomy (surgery to remove the entire uterus). OBGYNs have developed a number of procedures and surgeries to treat this common and burdensome problem. Medications and the progesterone IUD can help. Gynecologists can remove the fibroids via laparoscopic surgery, robotic surgery, open surgery, and sometimes hysteroscopic procedures (through the vagina, without any incisions). There are MRI-ultrasound procedures and a procedure that blocks off blood supply to the growing fibroids. Unfortunately, all of these procedures often help only temporarily and women end up needing more procedures, medications, or surgeries in the future. For instance, about one third of women who have fibroids surgically removed (“myomectomy”) need another intervention in the future.
One of the newest technologies for treating fibroids is called radiofrequency volumetric thermal ablation (RFVTA). In this procedure, the surgeon uses laparascopy and ultrasound to identify the fibroids and zap them from the inside. Here is a simplified look at the steps of the procedure.
1. The patient takes a NSAID and an antibiotic before the procedure.
2. After anesthesia, the surgeon inserts a tiny camera on a stick into the abdomen to look at the uterus and fibroids. She then inserts a tiny ultrasound on a stick. The surgeon then creates a map of all the fibroids with their sizes and locations.
3. The surgeon inserts the “radiofrequency ablation” handpiece (the zapper) through the skin into the abdomen and then 1 centimeter into the fibroid.
4. The surgeon deploys the “electrode array” (again, simplified, the zapper) and ablates (zaps) the fibroid for a set period of time, based on the size of the fibroid.
5. The surgeon zaps all the fibroids.
6. Voila! Treatment over. The surgeon closes up the tiny incisions for the camera and ultrasound using standard techniques.
The patient usually needs NSAIDs (like Motrin or Aleve) after the procedure and may experience a heavy period or drainage as the fibroids are resorbed. Most women are back to work in 2 to 7 days. Women have a shorter hospital stay and shorter recovery. Most excitingly, research shows that patients’ symptoms decrease after the procedure and only 11% of women required another intervention after 3 years. Although the treatment has not been tested for treating infertility due to fibroids, recent reviews have shown that 10 women have become pregnant after RFVTA.
Dr. Bruce Lee of Monterey, California, first invented the technology, known by the commercial name Acessa, in 2002. He then co-founded the company Halt Medical with Jeffrey Cohen to commercialize and manufacture the technology, which launched in 2012. Since that time, Acessa has shown much promise, with a 94% satisfaction rate in addressing symptoms. Only time will tell how far this technology will go and what the future holds in this new tool in OBGYNs’ toolbox of treatments for fibroids.