Fibroid Treatments Demystified, Part II: Radiofrequency Ablation (Acessa Procedure)
How Radiofrequency Ablation (RFVTA) Works
Acessa’s RFVTA is performed laparoscopically in an outpatient setting, with the patient under general anesthesia. The surgeon makes two tiny abdominal incisions (no wider than 1/4 inch), and inserts a scope, which allows for visualization of the uterus, followed by a laparoscopic ultrasound probe which is used to detect fibroids not seen through the scope. Once fibroids have been located, the surgeon uses a special probe (the Acessa handpiece) with a retractable electrode array to directly apply a controlled volume of heat to the fibroid. Once treated with heat, the destroyed fibroid tissue shrinks and is typically reabsorbed by the body. The treatment targets only the fibroid tissue, so healthy tissue in surrounding organs is unharmed.
Clinical research has shown radiofrequency ablation to be very effective in shrinking or completely eliminating fibroids. The use of laparoscopic ultrasound reduces the risk of symptom recurrence by allowing the physician to find and treat all fibroids present in the uterus, not just the ones that were identified through previous diagnostic imaging. Study data from the team of Chudnoff et. al indicate that, at 12-months post-treatment, 94% of RFVTA patients had seen lasting reduction in symptoms and improved quality-of-life, and device-related complications were low (3.6%). A study by Guido et al. affirmed the findings of Chudnoff’s team and reported that 6 of 124 patients (4.8%) required surgical reintervention for fibroid-related bleeding between 12 and 24 months post-treatment. After three years of follow-up in the same group of patients, Berman et al. reported that symptom reduction and quality of life were sustained.
Limited data exists regarding fertility and pregnancy outcomes related to RFVTA, so RFVTA cannot yet be indicated for women seeking pregnancy. Commenting on the results of an early feasability study, Lee et. al reports, “future pregnancy and potential vaginal delivery post RFVTA are being explored in three trials, respectively, in Canada, California, and Germany.”
Radiofrequency ablation is a uterine-sparing procedure, and it is a less invasive surgical option for women who are looking to avoid hysterectomy. Since it is one of the newer fibroid treatments available, women may be challenged to find doctors who are trained in the procedure. However, as awareness and demand for the procedure grows, additional doctors will seek training in the technique of radiofrequency ablation for the treatment of uterine fibroids. In a 2013 article profiling Acessa’s RFVTA, Dr. James Macer commented, “patients are increasingly aware of uterine sparing treatments for symptomatic fibroids. Women seek conservative procedures to avoid the risks and extended recovery times commonly associated with major surgery.”
- American Society for Reproductive Medicine, “Treatment of Uterine Fibroids”, ReproductiveFacts.org: 2011. Retrieved May 25, 2015, from http://www.reproductivefacts.org/FACTSHEET_Treatment_of_Uterine_Fibroids/
- Berman, J.M. et al. “Three years’ outcome from the Halt trial: a prospective analysis of radiofrequency volumetric thermal ablation of myomas,” Journal of Minimally Invasive Gynecology. 2014; 21(5):767-774
- Chudnoff, S. et al. “Outpatient procedure for the treatment and relief of symptomatic uterine myomas”, Obstetrics and Gynecology. 2013; Vol. 121(5):1075-1082
- Guido, R. et al. “Radiofrequency volumetric thermal ablation of fibroids: a prospective, clinical analysis of two years’ outcome from the Halt trial”, Health Quality Life Outcomes. 2013; Vol. 11(139):1-8
- Lee, B. et al. “Ch. 9: Radiofrequency Volumetric Thermal Ablation of Symptomatic Uterine Fibroids: The Acessa Procedure.” In Leiomyomas: Risk Factors, Clinical Manifestations and Treatment Options, edited by A. Al-Hendy and S. Salama, p. 186-190. Nova Science, 2015.
- Macer, J. “For uterine-sparing fibroid treatment, consider laparoscopic ultrasound-guided radiofrequency ablation”, OBG Management. Nov. 2013; Vol. 25(11):50-55