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Focused Ultrasound Surgery for Uterine Fibroids

Uterine fibroids are non-cancerous tumors that grow in the uterus and can be treated through focused ultrasound surgery. The procedure is also known as magnetic resonance-guided focused ultrasound surgery and focused ultrasound ablation. The procedure is straightforward and non-invasive. Your surgery will be done in the magnetic resonance imaging (MRI) scanner. 

The MRI scans help your doctor better understand the density, shape, and location of fibroids inside your uterus. They also provide the doctor with a proper understanding of the surrounding structures that are to be avoided during the surgery. The sound waves delivered by the ultrasound transducer heat up and destroy the fibroid tissue until the entire fibroid is eliminated. 

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What should I know about a focused ultrasound surgery?

You should note that the length of the focused ultrasound surgery varies, depending on the number and size of fibroids. 

  • Your doctor will ask you to lie down on your stomach. The surgical team will monitor you and the procedure from the adjacent room throughout the process. You can see, hear, and talk to them during the procedure. 
  • Your focused ultrasound surgery will begin while you are in the MRI scanner. 
  • Focused ultrasound waves will heat up and destroy your fibroids. During the procedure, the MRI machine will constantly monitor the temperature and determine the desired output results. 
  • Each sound wave takes 12 to 30 seconds to destroy the fibroid, and there will be a 45- to 90-second cooling-off period for each sound wave to allow the tissue to cool down. 
  • You can inform your medical team if you feel any discomfort in the middle or at any time during the surgery. 

Why is a focused ultrasound surgery performed for uterine fibroids? 

A focused ultrasound surgery is performed for uterine fibroids in any of the following conditions. 

  • If you are experiencing excessive menstrual bleeding, pressure, and pelvic pain due to uterine fibroids
  • Since it is a non-invasive, simple alternative to surgical methods
  • To help you return to your daily routine after the procedure
  • If you are a woman and want to have children in the future

It may not be a good option for you if:

  • You have multiple abdominal scars which makes it difficult to find a safe path between the fibroid and the transducer 
  • If your doctor diagnoses you with large or numerous fibroids
  • If your doctor is doubtful whether your fibroid is a cancerous growth

What can you expect before the procedure?

You may have to undergo a couple of tests and take precautions, as prescribed by your doctor. 

  • Your doctor may prescribe a pregnancy test to ensure that you are not pregnant. 
  • Sometimes, your doctor may also suggest a pelvic MRI scan. 
  • Your surgical team will request you to change into surgery clothing. 
  • Your medical team may also ask you to leave the jewelry on your body and electronic items behind before the procedure  
  • You have to inform your doctor regarding the presence of metal or electronic devices inside your body, such as cochlear implants. 
  • The day of treatment you will need to shave your lower abdomen between your pubic bone and bellybutton.
  • Your doctor might request you to fast for a few hours before the surgery. 

Shortly before the beginning of the procedure: 

  • An intravenous line is placed in one of your veins in order to inject the contrast material for MRI and to give you medicines for pain and relaxation 
  • Special stockings are put on your legs to prevent blood clots 
  • A urinary catheter is inserted into the bladder to keep your bladder stable during the treatment and improve visibility of your uterus

During the treatment, the MRI scan allows your doctor to evaluate the effects and define areas that need additional treatment.

What to Expect During the Surgery

  • Using focused sonications (ultrasound waves), each part of the fibroid is heated. MRI scan is used to monitor the tissue temperature and also to find out if the fibroid was heated enough to achieve the desired outcomes. This process is repeated till most of the fibroid is sufficiently heated and reached a temperature that can destroy the tissue.
  • Each sonication may last about 12 – 30 seconds, which is followed by a 45- to 90-second rest period for the tissue to cool down. To destroy a fibroid, it generally takes 50 or more sonications during a treatment session. But, depending on the size and number of the fibroids, you may have to undergo more sonications or a second treatment may become necessary.
  • Throughout this treatment, you will be asked about the level of your discomfort so that your medicine can be adjusted or other necessary changes can be made.

What can you expect after a focused ultrasound surgery? 

A focused ultrasound surgery is, non-invasive procedure. With proper after-surgery care and precautions, you can optimize your recovery process. 

  • You may have to make transport arrangements to return home after the surgery. 
  • Your doctor will ask you to stay in the hospital for at least five hours after the surgery for observation and make sure that you don’t develop any adverse effects. 
  • Your doctor will administer medication after surgery. So, you will have to remain in the hospital for some time. 
  • You can go back to your everyday routine a day after the surgery.
  • Your doctor will prescribe painkillers to cope with the after-surgery pain. 

What are the risks associated with a focused ultrasound surgery? 

Although a focused ultrasound surgery has minimal side effects compared to its surgical counterpart, risks cannot be ruled out altogether. 

  • The sound waves might hurt and burn the skin surrounding the abdomen. 
  • The temperature from the sound waves may sometimes hurt the tissues and organs near the area of treatment. However, this happens in very rare cases, as only specialized doctors perform the procedure
  • Sometimes, you might hurt your nerves near the area of treatment that may cause temporary leg and back pain. 
  • Deep vein thrombosis, a condition where a blood clot forms in your back or legs, may occur. 
  • Less data and evidence are available to conclude the efficacy of a focused ultrasound surgery for uterine fibroids regarding fertility and pregnancy
  • There is very little data available to prove its efficacy over other treatment methods. 
  • There is no guarantee that a focused ultrasound surgery will destroy the fibroids. You might need another surgery if your symptoms reemerge. 

Conclusion

A focused ultrasound surgery for uterine fibroids is an effective alternative to most invasive methods. The minimal recovery time and fewer side effects make it a preferred treatment option.

Frequently Asked Questions (FAQs)

Should I go to the hospital before the surgery? 

No. You don’t have to visit the hospital before the surgery. As it is a simple procedure, you only need to reach the hospital in time for the surgery. 

I am pregnant. Am I eligible for this surgery? 

No. Pregnant women should not  undergo this surgery. However, you can contact your doctor for a consultation regarding the procedure. 

Will I be hospitalized after the surgery? 

No. You will have to stay in the hospital for only a day. You will be discharged and can resume your routine the day after your surgery. 

How many hours does the surgery take? 

The duration of the surgery usually depends on the size and number of fibroids. However, this surgery typically takes a minimum of three hours. 

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