Multidisciplinary management to optimize outcome of ultrasound-guided high-intensity focused ultrasound (HIFU) in patients with uterine fibroids

Florian Recker,Kai Wilhelm,Ulrike Attenberger,Birgit Bette,Alexander Mustea,Holger Strunk,Simone Welz,Milka Marinova,Sara Dohmen,Guido Luechters,Rupert Conrad,Ullrich Wüllner,Tolga Tonguc,Babak Salam,Eva K Egger,Marcus Thudium

doi:10.1038/s41598-021-02217-y

Abstract

Little is known about the specific anaesthesiological and multidisciplinary management of high-intensity focused ultrasound (HIFU) in uterine fibroids. This observational single-center study is the first reporting on an interdisciplinary approach to optimize outcome following ultrasound (US)-guided HIFU in German-speaking countries. A sample of forty patients with symptomatic uterine fibroids was treated by HIFU. Relevant treatment parameters such as total treatment time for intervention, anaesthesia, and sonication time as well as total energy, body temperature, peri-interventional medication and complications were analyzed. Interventional variables did not correlate significantly either with opioid dose or with body temperature. The average fibroid volume reduction rate was 37.8% ± 23.5%, 48.5% ± 22.0% and 70.2% ± 25.5% after 3, 6 and 12 months, respectively. No major anaesthesiological complications occurred apart from an epileptic seizure prior to HIFU treatment in one patient. Peri-procedural hyperthermia (> 37.5 °C) occurred in two patients. Post-procedural two patients experienced a sciatic nerve irritation up to one year; one patient with very large treated fibroid experienced strong short-lasting post-procedural pain. There were two complication-free pregnancies of HIFU-treated patients. Multidisciplinary management is crucial to optimize safety and outcome of US-guided HIFU for uterine fibroids. Peri-procedural pain and temperature management are critical points where an adequate collaboration between anesthesiologist and interventionalist is mandatory.

Highlights

Uterine fibroids are the most common benign tumors among women in the reproductive age
Our study lends further evidence for the fact that in the highintensity focused ultrasound (HIFU) setting, peri-procedural temperature management represents a challenge for both, the anesthesiologist and the interventionalist
The abdominal wall has to be cooled during the procedure to prevent skin burn and injury, which is especially important in patients with scars

Summary

Introduction

Uterine fibroids are the most common benign tumors among women in the reproductive age. Fibroids are thermally ablated via non-invasive approach by concentrating ultrasound energy on a small tissue area, causing coagulation necrosis and destruction of selected tissue[5,6]. With a very low complication rate, HIFU provides an effective treatment option in patients suffering from fibroid-associated symptoms. Comprehensive patient counseling regarding different treatment options for symptomatic uterine fibroids encompasses medication-based and surgical, and non-surgical treatment options[7,8]. To the best of our knowledge such data on USgHIFU of symptomatic uterine fibroids are reported for the first time from German-speaking countries and Europe apart from a small study from Oxford with 12 HIFU-treated patients in 2 0199

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