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Endometrial Ablation vs. Radiofrequency Ablation: What’s The Difference?

 

The term “ablation” refers to a process by which tissue is destroyed, typically using either heat (thermal ablation) or cold (cryoablation). Ablative technologies are used to treat numerous medical conditions, including gynecological issues. We often hear of two procedures in particular, endometrial ablation, and radiofrequency ablation, and many people confuse the two treatments. Don’t let the similar names deceive you though: while both procedures leverage ablative technology, they are very different in their applications. To clear up the confusion, here’s a rundown on the defining characteristics of the two ablation therapies.

Endometrial Ablation (EA)

How EA Works
Endometrial ablation is typically used to treat prolonged, abnormal uterine bleeding. It does so by ablating the lining of the uterus, known as the endometrium, permanently destroying the tissue. There are several different methods of endometrial ablation: these include freezing (cryoablation techniques), directly applying heat from fixed-frequency microwaves or radiofrequency energy; and using hot fluid through techniques like balloon endometrial ablation.

In EA, treatment is limited to the endometrial layer, the surface tissue that lines the uterine cavity, and the basalis layer, where the endometrial tissue originates. Destroying the basalis layer prevents new tissue from growing, thereby reducing or eliminating menstrual bleeding.

EA procedures are performed in an office or hospital setting, usually with the patient under conscious sedation. Patients typically go home the same day, and full recovery takes about 1-2 weeks, depending on the specific procedure.

Outcomes
Endometrial ablation is used to control prolonged, abnormal vaginal bleeding. EA is most appropriate for patients that have completed childbearing, who have not seen results from other treatment approaches, and who are seeking an alternative to hysterectomy.

In most cases, EA meets its objective: an estimated 9 out of 10 women have lighter periods or no periods after undergoing the procedure. However, it’s difficult to predict whether a woman’s bleeding will stop completely. Estimates regarding the incidence of amenorrhea (the absence of menstrual bleeding) after EA vary widely from one study to the next, but it’s typically estimated to fall between 20% and 50%. A study by El-Nashar et al. asserted that the likelihood of amenorrhea occurring after EA depends on the type of ablative technology used, as well as patient characteristics like age and uterus size. Regardless, amenorrhea is not a guaranteed outcome. “If… a woman’s goal is amenorrhea, hysterectomy is the only reliable op¬tion,” reports Dr. Joseph Sanfilippo in an update to the medical community on EA-related developments.

It is important to note that endometrial ablation is not indicated for the treatment of uterine fibroids; any destruction of fibroids in the process of ablating the endometrium is incidental. Fibroids that grow partially or entirely within the walls of the uterus (known as intramural fibroids), as well as those growing outside the uterus (subserosal fibroids), are not reached during ablation. Those that protrude into the uterine cavity (submucosal) are sometimes shaved down hysteroscopically before ablation; however, if the fibroid originates below the basalis layer of tissue, it cannot be completely eradicated during ablation and may grow back, following the procedure.

Radiofrequency Ablation (Acessa Procedure)

How RFVTA Works
Radiofrequency ablation (short for “radiofrequency volumetric thermal ablation”, or RFVTA) is a specific ablation technique that is used to treat uterine fibroids in a procedure known as Acessa. In the Acessa procedure, a controlled volume of heat is applied directly to the fibroid, killing the tissue of the fibroid while leaving healthy surrounding tissue unharmed. Once the fibroid is destroyed, the dead tissue is simply reabsorbed by the body.
In performing RFVTA, a scope and a laparoscopic ultrasound probe are inserted through the abdominal incisions. Using the scope in conjunction with the ultrasound probe allows the operating physician to precisely pinpoint the fibroids’ location. Once the fibroids have been located, the surgeon uses a special tool with a retractable electrode array (the Acessa handpiece) to ablate the fibroid with radiofrequency energy.
RFVTA is performed in an outpatient setting. The surgery is minimally invasive: with the exception of two tiny incisions (no wider than 1/4 inch) on the abdomen, there is no cutting or suturing of uterine tissue. Patients go home the same day and return to normal activities within 2-3 days.

Outcomes
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. At 36 months post-treatment, 90% of patients needed no additional fibroid treatment. Though objectively measured bleeding at 12 months of follow up decreased in 82% of the women treated with RFVTA, the goal of treatment was not to destroy the endometrium or induce amenorrhea but merely to treat the fibroids.
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In the field of gynecology, ablation techniques can be used in addressing multiple conditions but it’s important to understand the difference between the technologies. Radiofrequency ablation with Acessa is an effective method for treating only the uterine fibroids without harming the rest of the uterus, whereas endometrial ablation effectively controls abnormal vaginal bleeding by directly ablating the lining of the uterus. Their usefulness is entirely related to their objective, and despite the commonality of a name, these procedures are very different in the objectives they serve.

SOURCES:

  1. American Society for Reproductive Medicine, “Endometrial Ablation”, ReproductiveFacts.org: 2011. Retrieved May 28, 2015, from http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endoablation.pdf
  2. El-Nashar, S.A. et al. ” Prediction of Treatment Outcomes After Global Endometrial Ablation”, Obstetrics & Gynecology, Jan. 2009; 113(1): 97–106. doi:10.1097/AOG.0b013e31818f5a8d.
  3. Sanfilippo, J. “Update: Options in Endometrial Ablation”, Supplement to OBG Management, Dec. 2009
  4. Berman, J.M. et al. “Three Years’ Outcome from the Halt Trial: A Prospective Analysis of Radiofrequency Volumetric Thermal Ablation of Myomas”, The Journal of Minimally Invasive Gynecology, 2014.

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Fibroids’ Psychological Toll

Fibroids hurt. The pain isn’t just physical: the psychological toll that comes with symptomatic fibroids is profound. In a 2014 study on the emotional impact of fibroids, researchers at Northwestern University’s Feinberg School of Medicine surveyed 48 women who had diagnosed, symptomatic uterine fibroids. The researchers found that the majority of those women had a “significant emotional response to their fibroids, ranging from general worry and concern to fear, anxiety, sadness, and depression”. More than half of the study’s participants reported feeling as though they had no control over their fibroids, mostly due to the difficulty of managing and predicting the heavy menstrual flow that is characteristic of the condition. The majority felt disempowered and possessed a “negative self-image”. The women also frequently expressed “concern over appearing pregnant, overweight, and less attractive”. Many of them expressed that the insecurities made intimacy with a partner difficult.

Despite both the physical and emotional suffering that the condition engenders, the prevailing attitude among women with fibroids seems to be that the condition is one to simply be endured. They resign themselves to “toughing it out”. Why would they voluntarily suffer? The answer partly lies in the woman’s perception of normalcy surrounding her experience with fibroids, according to researchers. M.S. Ghant et al. discovered in their 2014 study that many of the women they surveyed had delayed seeking a diagnosis for their heavy menstrual bleeding because they believed what they were experiencing was essentially a normal burden of womanhood. Even after receiving a diagnosis of fibroids, the researchers reported, many did not seek treatment: instead, they frequently minimized their suffering and “expressed that they were ‘just dealing’ with their fibroids”.

Fear about invasive treatments and the consequences of procedures like hysterectomy are clearly major deterrents for many fibroid sufferers who would otherwise seek treatment. Fortunately, new, outpatient treatment options like the Acessa Procedure offer women with fibroids alternatives to hysterectomy and invasive surgery. Evidence suggests that treating fibroids through a minimally invasive procedure of this nature leads to improved quality of life and psychological wellbeing.

A 2013 study by Guido et al. examined the impact of fibroid treatment via radiofrequency volumetric thermal ablation (also known as Acessa Procedure) on various aspects of patient’s wellbeing. Using the participant’s responses to follow-up questionnaires at 3, 6, 12 and 24 months post-procedure, the research team measured improvements in multiple quality-of-life factors, including: Concern, Activities, Energy/Mood, Control, Sexual Function, and Self-Consciousness. They concluded that the women participants, “showed significant improvement in their symptom severity and health-related quality of life [in the first] 3 months post treatment”. Moreover, the effects seemed to last; the researchers noted that the improvements they observed, represented in the graph below, were “sustained over 2 years, accompanied by a low rate of re-intervention (4.8%)”.

As awareness of minimally invasive treatment options increases, perhaps the painful emotions like fear, anxiety, and depression that commonly precede treatment decisions will be alleviated, and “toughing it out” will no longer be perceived as necessary. Moreover, for those women who take the next step of treating, rather than enduring, their fibroids through a minimally invasive procedure, the outlook for an improved emotional, physical, and mental state is a positive one.

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SOURCES:

  1. Ghant, M.S. et al. “An altered perception of normal: a qualitative assessment of women’s experiences with symptomatic uterine fibroids”, Fertility & Sterility. Sept 2014; Vol. 102(3):255.
  2. Ghant, M.S. et al. “Beyond the physical: a qualitative assessment of the emotional burden of symptomatic uterine fibroids on women’s mental health”, Fertility & Sterility. Sept 2014; Vol. 102(3):329.
  3. Guido et al. “Radiofrequency volumetric thermal ablation of fibroids: a prospective, clinical analysis of two years’ outcome from the Halt trial”, Health and Quality of Life Outcomes 2013 11:139.

 

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