Uterine Leiomyoma Journey With Acessa ProVu System Using General Anesthesia Under Laparoscopic Ultrasound Guidance: A Case Report

Abstract

This case report details the evaluation and management of a 40-year-old woman presenting with heavy menstrual bleeding and severe dysmenorrhea. Despite three months of combined oral contraceptives, symptoms persisted. The patient denied other systemic symptoms, with no weight loss, fatigue, or urinary/fecal symptoms. No visual, cardiovascular, pulmonary, abdominal, neurological, or mental health issues were reported. Pelvic imaging revealed a 7 cm × 4.3 cm FIGO 4 fibroid. The chosen treatment was laparoscopic radiofrequency ablation (Acessa) due to its efficacy, safety, and faster recovery. The case highlights the importance of a comprehensive approach to diagnosing and treating abnormal uterine bleeding.

Keywords: acessa provu; anesthesia; fibroid uterus; general anesthesia; ultrasound-guided; vascular leiomyoma.

Figure 1. Ultrasound before and after procedure

(A) Transvaginal image of pelvic organs with sonohystogram demonstrates fluid-filled endometrial cavity with catheter and saline water, negative for polyps or submucosal fibroids. Left lateral anterior intramural fibroid 7.00 cm x 4.31 cm depicted with a blue arrow and white cross on top of the fibroid to demonstrate the height and width. (B) After the procedure, the left lateral anterior intramural fibroid shrieked to 4.07 cm x 2.76 cm depicted with a blue arrow and white cross on top of the fibroid to demonstrate the height and width. The ultrasound machine used in the office to visualize pelvic organs was the Philips EPIQ 5 Ultrasound system. A transvaginal transducer was utilized to perform the saline-infused sonogram. The EPIQ 5 system was launched in 2013 and it features improved imaging technology. This includes the MaxVue high-definition display which allows extraordinary visualization of anatomy with 1,179,648 additional image pixels compared to a standard 4:3 display format mode.