High-intensity focused ultrasound: opportunities and prospects in the treatment of uterine fibroid and deep infiltrative endometriosis

2021 ◽  
Vol 70 (2) ◽  
pp. 129-138
Author(s):  
Dmitriy S. Sudakov ◽  
Igor P. Nikolayenkov ◽  
Yulia R. Dymarskaya ◽  
Diana V. Bubnova
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Uterine Fibroid ◽  
Focused Ultrasound ◽  
Uterine Fibroids ◽  
High Intensity Focused Ultrasound ◽  
Deep Infiltrating Endometriosis ◽  
Unplanned Pregnancies ◽  
Infiltrating Endometriosis ◽  
Deep Infiltrative Endometriosis

This literature review is devoted to the use of focused ultrasound in gynecological practice as an alternative to the traditional surgical treatment of uterine fibroids and deep infiltrating endometriosis. According to available data, the effectiveness of the treatment of uterine fibroids with focused ultrasound varies widely, ranging from 16.4% to 93.0%. Due to the lack of prospective studies, it is not possible to draw reliable conclusions about the effect of ablation of uterine fibroid with focused ultrasound on fertility. However, unplanned pregnancies after such treatment occurred up to 19.5%, and in 66.3% of cases, pregnancies ended with the childbirth. Research results demonstrate that in 87% of cases, treatment of retrocervical infiltrative endometriosis using focused ultrasound is feasible. Further data accumulation is required to determine the range of patients with uterine fibroids and deep infiltrating endometriosis, to whom the treating technique could be most effective and safe.

scholarly journals Comparison of (Cost-)Effectiveness of Magnetic Resonance Image–Guided High-Intensity–Focused Ultrasound With Standard (Minimally) Invasive Fibroid Treatments: Protocol for a Multicenter Randomized Controlled Trial (MYCHOICE) (Preprint)

2021 ◽  
Author(s):  
Kimberley J Anneveldt ◽  
Ingrid M Nijholt ◽  
Joke M Schutte ◽  
Jeroen R Dijkstra ◽  
Geert W J Frederix ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Uterine Fibroid ◽  
Focused Ultrasound ◽  
Controlled Trial ◽  
Uterine Fibroids ◽  
High Intensity Focused Ultrasound ◽  
Hifu Treatment ◽  
Image Guided ◽  
Randomized Controlled

BACKGROUND Magnetic resonance image–guided high-intensity–focused ultrasound (MR-HIFU) is a rather new, noninvasive option for the treatment of uterine fibroids. It is safe, effective, and has a very short recovery time. However, a lack of prospectively collected data on long-term (cost-)effectiveness of the MR-HIFU treatment compared with standard uterine fibroid care prevents the MR-HIFU treatment from being reimbursed for this indication. Therefore, at this point, when conservative treatment for uterine fibroid symptoms has failed or is not accepted by patients, standard care includes the more invasive treatments hysterectomy, myomectomy, and uterine artery embolization (UAE). Primary outcomes of currently available data on MR-HIFU treatment often consist of technical outcomes, instead of patient-centered outcomes such as quality of life (QoL), and do not include the use of the latest equipment or most up-to-date treatment strategies. Moreover, data on cost-effectiveness are rare and seldom include data on a societal level such as productivity loss or use of painkillers. Because of the lack of reimbursement, broad clinical implementation has not taken place, nor is the proper role of MR-HIFU in uterine fibroid care sufficiently clear. OBJECTIVE The objective of our study is to determine the long-term (cost-)effectiveness of MR-HIFU compared with standard (minimally) invasive fibroid treatments. METHODS The MYCHOICE study is a national, multicenter, open randomized controlled trial with randomization in a 2:1 ratio to MR-HIFU or standard care including hysterectomy, myomectomy, and UAE. The sample size is 240 patients in total. Women are included when they are 18 years or older, in premenopausal stage, diagnosed with symptomatic uterine fibroids, conservative treatment has failed or is not accepted, and eligible for MR-HIFU. Primary outcomes of the study are QoL 24 months after treatment and costs of treatment including direct health care costs, loss of productivity, and patient costs. RESULTS Inclusion for the MYCHOICE study started in November 2020 and enrollment will continue until 2024. Data collection is expected to be completed in 2026. CONCLUSIONS By collecting data on the long-term (cost-)effectiveness of the MR-HIFU treatment in comparison to current standard fibroid care, we provide currently unavailable evidence about the proper place of MR-HIFU in the fibroid treatment spectrum. This will also facilitate reimbursement and inclusion of MR-HIFU in (inter)national uterine fibroid care guidelines. CLINICALTRIAL Netherlands Trial Register NL8863; https://www.trialregister.nl/trial/8863 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29467

scholarly journals Robot-assisted Ultrasound-guided Tracking of Anatomical Structures for the Application of Focused Ultrasound

2020 ◽  
Vol 6 (3) ◽  
pp. 123-126
Author(s):  
Michael Unger ◽  
Johann Berger ◽  
Bjoern Gerold ◽  
Andreas Melzer
Keyword(s):  
Focused Ultrasound ◽  
Varicose Veins ◽  
Tracking System ◽  
Tracking Error ◽  
Uterine Fibroids ◽  
High Intensity Focused Ultrasound ◽  
Robot Assisted ◽  
Anatomical Structures ◽  
Surgical Tool ◽  
Custom Made

AbstractHigh intensity focused ultrasound is used as a surgical tool to treat completely non-invasively several diseases. Examples of clinical applications are uterine fibroids, prostate cancer, thyroid nodules, and varicose veins. Precise targeting is key for improving the treatment outcome. A method for an automated, robot-assisted tracking system was developed and evaluated. A wireless ultrasound scanner was used to acquire images of the target, in this case, a blood vessel. The active contour approach by Chan and Vese was used to segment and track while moving the scanner along the target structure with a collaborative robotic arm. The performance was assessed using a custom made Agar phantom. The mean tracking error, which is defined as the remaining distance of the lesion to the images’ centre line, was 0.27 mm ± 0.18 mm.

Surgical treatment of patients with deep infiltrating endometriosis of the rectovaginal septum

2021 ◽  
Vol 20 (4) ◽  
pp. 5-11
Author(s):  
E.A. Galliamov ◽  
◽  
L.N. Aminova ◽  
V.A. Alimov ◽  
A.G. Kozub ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Comparison Group ◽  
Chronic Pelvic Pain Syndrome ◽  
Main Group ◽  
Pelvic Pain Syndrome ◽  
Deep Infiltrating Endometriosis ◽  
Rectovaginal Septum ◽  
Infiltrating Endometriosis

Objective. To optimize the tactics of surgical treatment of deep infiltrating endometriosis of the rectovaginal septum, including with bowel involvement. Patients and methods. The study included 122 patients diagnosed with deep infiltrating endometriosis of the rectovaginal septum, who underwent surgical interventions of different volumes using laparoscopy. The patients were divided into a main group and a comparison group. The main group consisted of 92 patients with deep infiltrating endometriosis of the rectovaginal septum who underwent surgical treatment using the original technique of systematic approach; the comparison group consisted of 30 patients who were operated using the generally accepted technique. Results. There was a statistically significant decrease in the operation duration, intraoperative blood loss, as well as more effective relief of dysmenorrhea and chronic pelvic pain syndrome, less complications and relapses in the main group compared to the comparison group. In addition, it was found that the combination of three symptoms such as dysmenorrhea, dyspareunia and chronic pelvic pain increase the likelihood of deep infiltrating endometriosis up to 93%. Conclusion. Based on the results obtained, the proposed method of surgical treatment of deep infiltrating endometriosis is more efficient and safer in comparison with the generally accepted technique, which can be considered as a valid reason for its wide introduction into clinical practice. Key words: deep infiltrating endometriosis, bowel endometriosis, surgical treatment of endometriosis, treatment algorithm

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