Acessa: A New Way To Treat Uterine Fibroids

Uterine fibroids are noncancerous tumors that originate from the muscle layer of the uterus. They are the most common tumor of the uterus and occur in up to 70% of women, however vary in incidence depending on ethnicity and family history. Uterine fibroids (also called leiomyomas) can range from a small pea size to even the size of a grapefruit or softball! As you can imagine, the larger a fibroid becomes the more problematic it can be, with pelvic pain and heavy and irregular bleeding being the most common symptoms women experience.

In the past, fibroids have been treated in various ways. Birth control pills, progesterone injections, and intrauterine devices (IUDs) have all been tried, but often with only modest success. Most often fibroids require surgery in the form of either a myomectomy or a hysterectomy. A myomectomy is the surgical removal of fibroids from the uterus. Unfortunately, even after removing them, new fibroids can still grow back. Hysterectomy is the most definitive form of surgery for fibroids, however this involves removing the entire uterus. While this surgery will eliminate any chance of fibroids returning, women often require large incisions (especially when the fibroids are large), lose their ability to have children, and also require a lengthy recovery time of up to six to eight weeks.

The good news is that a new technique called Acessa has been developed as a more minimally invasive way to treat uterine fibroids. It involves tiny incisions, good success rates, and short recovery times, all while preserving the uterus and without having to remove any native tissue or organs. Acessa is performed laparoscopically and uses radiofrequency ablation through a probe tip that is inserted through the belly and directly into the fibroid using ultrasound guidance. Once the tip is inserted into a fibroid, tiny microarrays are deployed directly into the tissue and heat is applied to destroy the fibroid from within. This procedure is performed on as many fibroids as are found by the ultrasound probe. Acessa is performed in a hospital or ambulatory surgical center under general anesthesia and usually takes around 1-2 hours. Patients are discharged the same day and typical recovery time is only around 3-7 days!

The success rates of the Acessa procedure are excellent. Clinical studies have shown that the vast majority of patients experience a significant reduction in their bothersome symptoms and an improvement in their quality of life.  In fact, in recent surveys, 98% of patients have reported overall satisfaction with the procedure and would recommend it to a friend.

If you think that you may have uterine fibroids because you suffer from either heavy or irregular periods, anemia, or pelvic pain, we encourage you to discuss this with your doctor at MacArthur OBGYN. Myomectomy or hysterectomy may still be good options for you.  However, we are now performing Acessa, a new minimally invasive way to treat your fibroids with small incisions, shorter recovery times, and preserving the uterus all at the same time!

New Minimally Invasive Procedure for Treatment of Fibroids


Dr. Andrea Arguello discusses a new procedure called Acessa for minimally invasive treatment of uterine fibroids. This procedure helps eliminate fibroid related symptoms without having to have a hysterectomy.

HTA Endometrial Ablation for Menorrhagia

Endometrial Ablation may be an alternative treatment option for pre-menopausal women with menorrhagia (excessive uterine bleeding) due to benign causes, for whom childbearing is complete. Menorrhagia is frequently treated by performing a hysterectomy. The HTA® System is designed to ablate the endometrial lining of the uterus without the need for surgery.

Ask yourself the following questions:

  1. Does your period last longer than seven days?
  2. Do you use more than 3 pads or tampons per day?
  3. Do you pass clots during your periods?
  4. Does your heavy bleeding affect your work, social, athletic or sexual activities?
  5. Has medication (birth control pills) failed to help your heavy bleeding?

If you answer yes to any one of these questions, you are likely suffering from heavy menstrual bleeding or menorrhagia.

Endometrial ablation is a procedure to treat abnormal uterine bleeding. The procedure is intended to destroy all or most of the tissue that is responsible for menstrual bleeding (the endometrium). After the procedure, patients may never bleed again, or if they do, their bleeding is generally reduced. Not all patients experience a satisfactory reduction in bleeding so all treatment options should be discussed with your doctor. In general, approximately 50% of women that have the ablation have no more menstrual cycles. Of the 50% that do continue to have a cycle, most have little bleeding and are satisfied with their results. The overall satisfaction rate is approximately 95%.

What are the reasons for undergoing the procedure?

If heavy bleeding during your periods is affecting your quality of life and you believe your options are to wait until menopause or to have a hysterectomy, there may be other choices for help without major surgery.

Intended Benefits of the Hydro ThermAblator® System (HTA® System):

  • A potential alternative to hysterectomy or other major surgical procedures.
  • An outpatient procedure usually performed in the office with only local anesthesia.
  • Decreased recovery period and generally fewer significant harmful side effects.

What is the HTA® System and how does the procedure work?

The Hydro ThermAblator System (HTA System) is a device that allows your gynecologist to perform endometrial ablation on an outpatient basis. This procedure involves your doctor inserting a probe into your uterus that includes a tiny telescope for viewing the lining of the uterus. Heated saline is circulated and is intended to destroy the lining of the uterus, even in a partial septate uterus or one with intra-mural fibroids ≤ 4cm, to eliminate or reduce bleeding to normal levels or less.

First, your cervix will be slightly dilated to allow the introduction of the telescope through the vagina, through the cervix and then into the uterus. This gives your gynecologist a view of the inside of your uterus to assure proper positioning. Then, your uterus will be filled with room temperature saline solution to gently clean and flush the uterus. The fluid will be heated to 90º C(194°F) and circulated in the uterus for ten minutes in order to treat the endometrium (lining of the uterus).

When the treatment is complete, the uterus will be flushed with room temperature saline to cool the uterus and the probe. All of the saline will be removed after the cooling phase is completed. Your uterine lining has been treated and will slough off similar to a menstrual period over the next few weeks.

Your gynecologist will do some pretreatment tests that may include a Pap smear, an ultrasound, endometrial biopsy, and/or a hysteroscopy (look inside the uterus with a tiny telescope) to see why you are having excessive menstrual bleeding.

Your physician will give you pain medication before the procedure to reduce cramping during or after the procedure. With the new technology and advancements available at MacArthur OB/GYN, most ablations are done in our office with only a local anesthesia injection.

After the procedure, you may experience some cramping that should go away by bedtime. You will probably have a pink or yellow watery discharge for a few weeks after your treatment. If you experience two days of heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours after the procedure, call your physician.

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection. Your monthly menstrual bleeding may be heavy for a few months after the treatment as a part of the healing process, and should improve after a few months.

You should not have this procedure if you desire pregnancy in the future. Endometrial ablation, however, does not prevent you from becoming pregnant and such a pregnancy would be high risk for both mother and fetus. Contraception or sterilization should be used after this treatment since pregnancy can still occur. Please discuss the different options with your physician. Also, all procedures carry risk. Ablation risk factors include bleeding, infection, damage to organs (uterine perforation, etc), and are something you should also discuss with your doctor.

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