High-Intensity Focused Ultrasound (HIFU)

Endometriosis: When Painful Periods Are Not The Norm

Endometriosis is an inflammatory condition that cause chronic pelvic pain and period pain. It affects  one in 10 women during their reproductive years. “Many unmarried young girls also have endometriosis,” says Dr S. Selva, Obstetrics and Gynaecology – IVF Consultant.

What Exactly Is Endometriosis?

Endometriosis is a disease in which the endometrial tissue, or the lining of the uterus, grows outside the uterus toits surrounding aresas and even to distant parts of the body.

A chronic and painful disease, Dr Selva points out that “many patients with endometriosis will have difficulty in getting pregnant.”

“Laparoscopic surgery when performed will benefit patients with endometriosis increaisng their chances of pregnancy and decreasing recurrence”.

IS GYNAECOLOGICAL LAPAROSCOPY THE ANSWER TO GYNAECOLOGICAL ILLNESSES?

Gynaecological laparoscopy also known as keyhole surgery, can be used to diagnose and treat a variety of  diseases such as:

  • Endometriosis
  • Pelvic inflammatory disease
  • Ectopic pregnancy
  • Ovarian cyst
  • Fibroids

Many different types of surgeries can be performed via laparoscopy. This includes:

  1. Cystectomy –removal of cysts
  2. Hysterectomy – removal of the uterus
  3. Oopherectomy – removal of the ovaries
  4. Salphingectomy removal of the fallopian tubes
  5. Adhesiolysis – release of adhesions
  6. Sacrocolpopexy – repair of a prolaped uterus
  7. Myomectomy – removal of fibroids

However, there are limitations to gynaecological laparoscopy. According to Dr Selva, “one of the problems with laparoscopic surgery is that certain disease like adenomyosis cannot be treated completely with laparoscopy”.

WHAT IS HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU)?

HIFU or High-Intensity Focused Ultrasound is a type of ultrasound surgery that uses focused sound energy to heat and destroy tissues. HIFU is currently used to treat various gynaecological conditions such as uterine fibroids and adenomyosis.

ARE THERE DIFFERENT TYPES OF HIFU?

Yes. There are two types of HIFU available – an MRI-based HIFU and an Ultrasound-based HIFU. Both uses HIFU to treat the fibroid. The only difference is the method of imaging used to look at tissues.

  • Magnetic Resonance Imaging Focused Ultrasound (MRgFUS)
    MRI-based HIFU that obtains images of the uterus using MRI.
    Focused Ultrasound Surgery (FUS)
    Uses diagnostic sonography to image the uterus. Even though the image may not be as clear as in MRgFUS the procedure is performed in real-time ultrasound imaging so it is more accurate.

“In MRgFUS, the image is very clear but the proceduce is not performed in real-time. FUS is performed with real-time ultrasound imaging so it is more accurate in the visualization and treatment of fibroid and adenomyosis.” says Dr Selva.

IF I CHOOSE HIFU, HOW DO I GET THE TREATMENT?

You will benefit most from a treatment when you know what is happening and are involved in the decision-making process. If you choose HIFU, Dr Selva says that it is important to “seek consultation from a specialist to understand whether the fibroid or adenomyosis can be treated by HIFU”.

You will first be placed on the machine to see whether the fibroid or adenomyosis is accesible by the machine.

Upon confirmation you will be expected to:

  • Perform an MRI and plan for a surgery
  • Preparation of the bowel begins five days before surgery
  • In the first two days, patients will undergo a low residue diet
  • In the next two days, patients are expected to go for a liquid diet

He adds that once the procedure is completed, “patients can return home from seven to eight hours after surgery.”

IS IT SAFE?

“It has very low complication rates when compared to gynaecological laparoscopy.”

According to Dr Selva, Mahkota Women and Child Centre has carried out more than 6,500 laparoscopic surgery, from straight forward to complicated procedures; from Single Incision Laparoscopic Surgery (SILS) to various new techniques.

“Complication to laparoscopic surgery is very low, the better trained the specialist the lesser the complications.”

“The most dangerous complication of laparoscopic surgery is injury the bowel, bladder and the ureter, but risks are as low as 1%. In HIFU, the risk of these complications is 1000x lower than that of laparoscopic surgery.”

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