Surgery using high-intensity focused ultrasound (HIFU) is fast being introduced as an alternative treatment to conventional surgery for uterine myomas (fibroids). Numerous studies have shown that it is a safe and effective treatment, with side effects far less significant than myomectomy and hysterectomy, and it is also cost-effective. This treatment option can now be offered to patients with symptomatic uterine fibroids.
In this paper we intend to describe the technical basis of ultrasound surgery, pre-treatment patient screening, limitations and the risks of treatment with high-intensity ultrasound.
HIFU is a new treatment method for solid tumours which acts on deep lesions, damaging only a specific focal point by thermal ablation, without disturbing the surrounding tissue. What is unique about this technology is that there is no need to introduce any type of device into the tissue being treated, and it is therefore the least invasive of all the emerging techniques.
Routine use of diagnostic ultrasound is so widespread it would now be virtually impossible to conceive of modern clinical practice without it. But in fact, originally, the medical interest in ultrasound was to produce tissue damage through the use of high-energy ultrasound (HIFU). Lindstrom1 and the Fry brothers (Illinois, USA) were the first to conduct research in this field in the 1950s, and HIFU was subsequently used to treat patients with Parkinson’s disease. Later, in the 70s and 80s, Lizzi et al. investigated the therapeutic properties of high-intensity ultrasound in ophthalmology for the treatment of detached retina and glaucoma.
HIFU technology was introduced in the treatment of solid tumours in the 90s for liver, pancreatic, prostate and bone cancers.
It was not until the early years of this century that studies began into the use of focused ultrasound surgery (FUS) to treat uterine fibroids. There are now 2 alternatives available for guidance of ultrasound surgery: magnetic resonance (MRgFUS) and diagnostic sonography (USgFUS).