Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is gaining increasing attention as a minimally invasive treatment for symptomatic leiomyomas. Systematic reviews demonstrate significant symptom improvement following MRgFUS treatment.[1][2] However, widespread use is hindered by insufficient evidence regarding fertility outcomes and minimal access to treatment services; in many centres, its use is largely limited to clinical trials.
A retrospective clinical audit was undertaken of patients undergoing MRgFUS treatment for fibroid symptoms within a tertiary health service between 2009 and 2013 inclusive. One hundred and ninety four patients received MRgFUS treatment during this period. These patients were cross-referenced with an existing leiomyoma database of a gynaecology unit to identify the number of patients with persistent fibroid symptoms requiring subsequent surgical management. One hundred and ninety four control patients who underwent surgical management of fibroids were also randomly selected from the leiomyoma database. Patient demographics were consistent between cohorts with an average age of 42 years for MRgFUS treatment and 43 years for surgical management.
Patients who had received MRgFUS treatment prior to their operation were then compared to the control cohort. This study assessed the potential role of MRgFUS in pre-operative optimisation for fibroid surgery by comparing length of surgical procedure, estimated intra-operative blood loss and length of hospital stay.
Consistent with international data, MRgFUS appeared to be an effective management for fibroid symptoms. Approximately 15% of patients required subsequent surgical treatment and 85% of these were required for persistent symptoms. The remaining 15% occurred for recurrent symptoms with the average time between MRgFUS treatment and symptom recurrence of 41.5 months.
Prima facie pre-operative MRgFUS does not appear to offer significant improvement in operative outcomes; both cohorts demonstrated similar procedure times, estimated intra-operative blood loss and length of hospital stay. However, the overall average time from MRgFUS to surgical management was almost two years. Moreover, on re-analysis, MRgFUS received within 12 months of surgery appeared to reduce overall operative time by approximately 15% and almost 30% when used within six months of surgery. These benefits were maintained across surgical procedures including hysterectomies and myomectomies.
This study discusses how these factors may interplay for the patient with symptomatic fibroids. Furthermore, the direction of future research will be outlined in order to be able to guide clinical decision-making for the gynaecologist seeking to provide up to date, safe and patient-centred care.