Once each patient is assessed and the decision made to carry out an HIFU procedure, we usually perform what we call a simulation: the patient is put in the treatment position in order to display the fibroids to be treated in the uterus, see whether there are bowel loops interposing and choose the transducer best suited for the case.
The week before treatment, we recommend a low-residue diet to prevent intestinal gas. Before treatment the abdomen has to be shaved.
For the procedure, the patient is placed prone on the moving HIFU table with her abdomen in contact with the degassed water.The treatment is performed under conscious sedation to reduce patient discomfort and a urinary catheter is inserted to control bladder volume during the procedure.
During treatment, the device parameters can be changed to cause smaller lesions and have better control of the volume being treated, or to apply more power in areas where less precision is required.
We usually use Sonovue ultrasound contrast to assess whether the whole fibroid has been treated before considering the treatment completed.
The effective treatment time may range from 30 min to 3 hours depending on the fibroids and their size and degree of vascularisation.
We do a control MRI with gadolinium after treatment to calculate precisely the non-perfused volume and immediately evaluate the effectiveness of the therapy (Fig. 10).
The patient is discharged the same day and, in general, can resume her normal activities immediately