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Times of India
15 December 2008

PT tells you about the latest medical procedure
Dr. Rakesh Sinha, MD, BEAMS in his clinic Dr. Rakesh Sinha, MD, BEAMS in his clinic
What are fibroids?
Fibroids are non–cancerous tumours of the uterus (womb) that grow in 25 per cent of women, they can be as small as a few centimetres or grow very large. Many women with fibroids do not have any symptoms. But as they grow, they may cause heavy menstrual bleeding, abdominal pain or discomfort, change in bladder and bowel habits, lump in abdomen and in some cases, infertility.

What is the treatment of fibroids?
Fibroids need treatment only if they are symptomatic or very large. The conventional way to manage fibroids is to remove them surgically. This is done under anaesthesia and removed through either an abdominal incision where patients may require between five–seven days of hospitalisation and adequate post–operative rest for recovery. Or it can be treated by laparoscopic myomectomy where recovery is faster. Here a laparoscope (telescope) is inserted through a tiny opening in the abdomen, two or three other small openings are made to insert instruments that can separate and remove the fibroids. This highly skilled surgery is done under general anaesthesia and the patient needs to be in hospital for only a day. The latest treatment modality for management of fibroids is HIFU.

What is HIFU (High Intensity Focused Ultrasound)?
It is the only non–surgical procedure to treat uterine fibroids. Ultrasound waves, when focused using a magnifying glass heating of tissue occurs. This principle is used in the hi–tech sophisticated HIFU machine where ultrasound waves are directed at the focal point so as to raise the temperature of the fibroid leading to its destruction. Continuous imaging of the target tissue during treatment helps to ensure a positive therapy outcome. This is a non–invasive outpatient procedure.

What are the benefits of HIFU?
It is an effective alternative to surgery and hormonal treatment. It is completely non–invasive – no surgery, no anaesthesia and no blood loss, no hospital stay. It preserves the uterus and cervix. There’s significant improvement in the quality of life and quick return to normal life.

What types of fibroids can be treated with the HIFU?
HIFU can be used for all types, ie, submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids in a location inaccessible by the focused ultrasound may not be treatable.

What is the treatment like?
The entire procedure takes place on a specialised treatment table where the doctor takes images to locate the uterus and the fibroid(s). Then these images are used to develop a treatment plan. When the treatment begins, a small beam of focused ultrasound is directed at the target for approximately 15 seconds and heats the tissue. Images are taken of the target tissue during the cycle. The system then moves to the next treatment point, and the process is repeated about once every 90 seconds until the entire volume has been treated. HIFU is performed as an outpatient procedure without any anaesthesia and takes approximately 30 minutes after which the patient can be sent home. The number of sittings varies according to each fibroid.

What happens if there is no relief with HIFU treatment?
If for any reason the patient does not get relief from her symptoms, our internationally trained team of surgeons will laparoscopically remove the fibroids.

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