Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids

Abstract

Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.

Figure 1

Consort diagram: assessment for eligibility and USgHIFU intervention.

Figure 2

Indication and contraindication for HIFU treatment of uterine fibroids.

Figure 3

Changes in fibroid volumes during follow up. Significant fibroid volume reduction rate was observed 6 weeks after HIFU compared to baseline (95% CI: − 52%, − 74%, p < 0.05). Lesion shrinkage improved continuously over the observational period at 3-, 6-, 9-month and 1-year follow-up (each p < 0.001, compared to baseline, mixed model). The figure was created using Stata 16 Software (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC).

Figure 4

A 45-year old patient with symptomatic uterine fibroids presented with menstrual complaints (hyper-dysmenorrhea), urination urge, pain/pressure in the pelvic region and was treated by USgHIFU in our hospital. Three weeks after HIFU, considerable symptom relief was observed. Representative MRI-images (a–e, contrast-enhanced T1-weighted in sagittal plane) of the largest uterine fibroid are shown over time before and after HIFU treatment: (a) baseline with initial fibroid size of 6.2 × 5.4 cm; (b) one day post-HIFU large treated region showed no contrast enhancement indicative of effective ablation; (c–e) A continuous reduction in fibroid volume after HIFU-treatment was observed, this was 66.4%, 84.6% and 90.1% after 6 months, 1 and 2 years, respectively.

Figure 5

Treatment options for uterine fibroids.