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UCLA Fibroid Treatment Program

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MR Guided Focused Ultrasound

MR Guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HiFU) is a revolutionary, completely non-invasive treatment option for some women with fibroids and shows great promise in the treatment of smaller and medium sized fibroids. This 'knifeless surgery' is done as an outpatient procedure and patients remain conscious but, sedated and feeling no pain. It does not require general anesthesia and recovery time is also significantly reduced compared with surgical alternatives. Although relatively new, this treatment option will give a subset of women a treatment choice that gives them fast recovery with limited side effects. Currently this procedure is FDA approved for pre-menopausal women with symptomatic uterine fibroids who have no desire for future pregnancy.

What is MR Guided Focused Ultrasound Surgery?

MR guided Focused Ultrasound Surgery is a non-invasive, outpatient procedure which uses high doses of focused ultrasound waves to destroy uterine fibroids, without affecting any of the other tissues around the fibroid. The procedure is conducted in a magnetic resonance imaging (MRI) scanner which helps the physician "see" inside the body to pinpoint, guide, and continuously monitor the treatment.

Imagine using a magnifying glass to focus the suns energy on a single point to create a flame to burn a leaf. The focused ultrasound energy is directed at a small volume of the fibroid, raising its temperature high enough to cause thermal ablation (killing of the cells) without impacting other tissues. Pulses of energy are repeated until the entire volume is treated.

What does the MR guidance provide?

Magnetic resonance imaging (MRI) is advanced diagnostic technology which provides 3D imaging of internal organs without radiation. The MR guided FUS treatment uses the MR images to identify where the fibroid is and what portion has been treated, without the need for any incisions. It also provides real time feedback about temperature changes of the treated fibroid to make sure that the fibrotic tissue has been ablated (destroyed).

What happens during the procedure?

During the procedure you lie on your stomach on a patient table that fits into a standard MRI scanner. First, the doctor identifies the fibroid(s) on MR images taken of your pelvic region. Then, after detailed planning, high energy focused ultrasound waves heat a small spot in the uterine fibroid to a temperature of up to 85°C. During the pulse or sonication, which lasts about 15 seconds, the doctor monitors the progress and reviews temperature-sensitive images. Since each sonication treats a very small volume, this process will be repeated until the required volume is treated, typically about 50 times. The procedure lasts about 3 hours depending upon the size and number of fibroids treated. Following the treatment the body gradually removes the treated tissue over a period of months, providing symptom relief.

What should I experience during the treatment?

Before treatment you are given a sedative and pain medication to help you relax. You lie on a patient table and are made comfortable before starting treatment. The treatment takes place with you lying on the patient table inside the MR scanner. Your clinical team will be in the next room with two-way communication using a microphone and a speaker. The doctor will inform you when images are being acquired (scanning) and when the system is sonicating (treatment).

During treatment, it is normal to feel a warming sensation in the pelvic region. You will be given a safety stop button that allows you to immediately stop the sonication if the treatment becomes painful. You are conscious the entire time and provide feedback during the procedure to the physician. Afterwards you'll be asked to rest for a few hours in the clinic, while the mild sedation wears off. Then you'll be able to go home and resume normal activity.

FAQ

How do I know if I'm a candidate for MR guided FUS?

If you require treatment for your fibroid related symptoms, but want to avoid surgery and preserve your uterus, contact us for a consultation. We will discuss your fibroid symptoms, general health and, medical history. You will also have routine blood work, an internal gynecological examination and MR imaging of your fibroids. Based on this information and your personal goals together we will decide the best treatment option for you.

What types of fibroids can be treated?

Your physician will determine if your fibroids are suitable for treatment. ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated per procedure. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.

What happens to me after the MR guided FUS procedure?

Following the treatment you will rest for an additional 45-90 minutes until the sedation wears off. After that you will be released and able to go home. You will receive discharge instructions from your doctor, depending upon how you are feeling. Usually nothing is required, although the doctor may recommend over-the-counter pain relief medication. Occasionally women may experience some cramping, similar to menstrual period cramping or shoulder/back pain from lying in the treatment position. Most women are able to return to work and normal activity 1-2 days after the procedure.

Could my fibroids come back after the treatment?

Although this treatment may be successful in destroying the fibroids causing painful symptoms, at a later time, more fibroids may grow, become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed.

What are the benefits of MRgFUS?
  • Effective alternative to surgery and hormonal treatment
  • Completely non-invasive - no surgery and no blood loss
  • No hospital stay
  • Quick return to normal activities
  • Preserves the uterus, cervix and ovaries
  • Significant improvement in your quality of life
    • decrease in menstrual bleeding from symptomatic fibroids
    • decrease in urinary dysfunction, pelvic pain and/or pressure


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