Abstract
Hysterectomy has been the traditional treatment for uterine leiomyoma; nowadays, however, many women opt for less invasive, uterus-preserving therapy. A new currently used technique, MR-guided focused ultrasound surgery (MRgFUS), is a less invasive procedure comprising real-time MR anatomic guidance, MR thermometry, and high-intensity focused ultrasound (HIFU). ExAbalte 2000 (InSightec, Israel) fully integrated with a 1.5T-MRI system (Signa, GE Healthcare, USA) was used in this study. Patients laid prone on the ExAblate table equipped with 208 beams from a phased-array transducer. The procedure, “scalpel-less surgery,” was carried out on an outpatient basis under conscious sedation, which required a short recovery time. About 75% of patients who underwent MRgFUS treatment in our hospital expressed satisfaction. Shrinkage of the leiomyoma and amelioration of symptoms were achieved 6 months after treatment, and pregnancies were achieved in several cases (despite current advice of contraindication). The system, ExAblate 2000, which was approved in 2009 in Japan for the treatment of uterine leiomyoma, entails very few and minor adverse events. Particular attention should be paid, however, to three major adverse events: skin burn, severe neuralgia, and intestine injury. The potential for improvements to MRgFUS includes shortening the duration of treatment, achieving a larger ablated volume, and placing the patient supine (a position requiring further studies on compression of vessels) on the ExAblate table. Another obstacle is extrusion of the bowel from the anterior of the uterus into the path of the ultrasound beam. In some cases, attempts at moving the bowel away from the ultrasound beam took 2 hours or even failed, resulting in the discontinuation of treatment. Our inquiries showed that 6 months after the treatment, about 2% of patients expressed regret at having undergone MRgFUS. Thus, patient selection before treatment with MRgFUS is important. It is expected after further study and worldwide trials that this technique may be applicable to those desiring fertility.
