Fibroid Surgery Without a Hysterectomy
Fibroids, by definition, are benign tumors. Over 80% of woman will have fibroids before the age of 50. However, approximately 60% are symptomatic and less than 40% seek medical management to address their fibroid symptoms. A main reason medical treatment is delayed is that women are not offered options that appeal to them or are only given the choice of a hysterectomy.
Fibroid management can be as simple as conservative observation with or without medical management, or it can require surgery. There are several surgical options that can address fibroids directly, some are minimally invasive and other requiring large incisions. The type of surgery that is recommended truly depends on the patient’s goals, including decreasing bulk, bloating and abdominal girth, or to stop heavy bleeding. Even more important is one’s desire for future fertility. Surgical intervention options are also determined based on the size and location of the fibroids. It is important for women to understand that a hysterectomy is rarely the only option. Asides from cancer or suspected cancer, most patients are great candidates for uterine sparing interventions and can keep their uterus if desired.
The newest technology for fibroid surgery is called Acessa. This is a minimally invasive, uterine sparing option. Acessa directly treats the fibroids, not the entire uterus. This procedure is an outpatient procedure and patients are able to return to work and their normal activities in a few days. Acessa is laparoscopic guided radiofrequency fibroid ablation. The procedure can be done in an outpatient surgical facility and requires general anesthesia. It is performed under laparoscopic guidance with two 1cm incisions and uses an ultrasound placed in the abdomen to visualize all of the fibroids growing throughout the uterus. With that visualization, both laparoscopically and with the ultrasound, a probe is placed into the fibroids and small electrode arrays are deployed. These are used to then heat up the fibroids for a short time depending on its size. Once complete, the probe is removed and the next fibroid is treated until all are ablated. The advantage of doing this treatment under direct ultrasound guidance is that the smallest of fibroids, which left untreated can grow to a larger size later, can be addressed before it becomes problematic or symptomatic. This method is proven to identify more fibroids than a transvaginal ultrasound and MRI. Occasionally the procedure is done in conjunction with a myomectomy. A myomectomy is necessary to remove fibroids that are either completely outside of the uterus and hang on by just a stalk (pedunculated) or completely inside the uterus and attached by just a stalk (type 0 submucosal). In those cases, Acessa is then used to treat all of the other fibroids that remain after the pedunculated or submucosal ones are removed. Acessa can even be done in conjunction with an endometrial ablation. The procedure takes less than an hour or a few hours depending on the size and number of fibroids.
Once the surgery is complete, patients are able to go home in about one to two hours. At home, the majority of patients only need Motrin to control their pain. There is minimal to no vaginal bleeding and no large incisions to heal from. You can return to work in 4-5 days and heavy lifting in a few weeks. Life is not put on hold for an extended period of time!
Effects of the treatment can be seen quickly within the first few months. Studies show that the improvement in bleeding, and pain is comparable to a myomectomy. Unlike uterine fibroid embolization, it is also regarded by obstetricians and gynecologist to be a safe procedure for women who desire future fertility because it only targets the fibroids, not surrounding tissue. Patients can also still have vaginal deliveries since no incisions are made on the uterus.
If you are interested in the Acessa procedure or any other uterine sparing minimally invasive surgeries to manage your fibroids, please contact Dr. Hawkins for a consultation today. Do not remain a statistic. Take your life back without a hysterectomy.