Title : Ultrasound-guided high-intensity focused ultrasound for the ablation of multiple uterine fibroids: Assessment of safety and efficacy
Abstract:
Background: Uterine fibroids is an extremely common benign gynecologic neoplasm with significant impact on quality of life and reproductive outcomes. Ultrasound-guided high-intensity focused ultrasound (Usg-HIFU) is a minimally invasive procedure that has been increasingly used to treat uterine fibroids. However, most of previous studies only used Usg-HIFU to ablate the largest myoma. The present study aimed to explore the safety and efficacy of Usg-HIFU to ablate multiple (≥3) myomas simultaneously.
Methods: In this single-center prospective study, consecutive patients with uterine fibroids treated with Usg-HIFU between January 2020 and March 2022 were included and analyzed. Patient demographics, pre- and post-ablation fibroid characteristics, perioperative complications, and short- and mid-term outcomes were collected and compared between those with Usg-HIFU ablation for 1-2 myoma (group A) and those with ablation for ≥3 myomas (group B). Severe perioperative complications were defined as those that requires specific interventions, such as bleeding that requires blood transfusion or surrounding organ damage that requires surgical intervention.
Results: Among the 129 patients (mean age 40.1 years) included, 41 (31.78%) patients underwent Usg-HIFU ablation targeting multiple myomas. No significant differences were observed with regard to patient’s age and medical comorbidities of hypertension and diabetes. Shrinkage of uterine fibroids (> 70% non-perfused volume ratio) treated with Usg-HIFU ablation was comparable between the 2 groups (81/88 vs 35/41, P=0.39). The rates of severe complications were minimal and comparable between group A and group B (1/88 vs 0/41, P=0.69). The operation time (P<0.001) and energy applied (P<0.001) was significantly longer in group B than in group A. The rate of symptoms relief at 3-month (74/88 vs 36/41, P=0.58) and 12-months (68/88 vs 30/41, P=0.61) follow-up were also similar between group A and group B.
Conclusion: Simultaneous ablation of multiple uterine fibroids with Usg-HIFU is safe and effective with profiles similar to ablation of 1-2 uterine fibroids.
