History of Energy-Based Fibroid Therapy

Energy-based platforms have been studied and used to treat uterine fibroids for over twenty years. These efforts have led to the development of a wide range of devices that are more minimally invasive and have the ability to improve patient symptoms as well or better than other traditional treatment methods such as myomectomy or hysterectomy.

Thermal Ablation

Thermal ablation devices treat the fibroid by heating the tissue. This heating is accomplished by converting some form of energy, usually electrical or light energy, into intracellular mechanical energy that creates heat within the cells of the target tissue. This heating process causes necrosis in the target tissue, which causes the fibroid to shrink, and usually stops the fibroid from causing symptoms for the patient.

The idea of ablating fibroids with energy was originally referred to as myoma coagulation or myolysis. It was initially performed using a laser to deliver energy to the fibroid during laparoscopy or hysteroscopy. The procedure evolved when the bipolar radiofrequency needle electrode was developed. The bipolar electrode was initially used in 1993 by Gallinat and Lueken. However, while the laser and bipolar methodologies demonstrated good efficacy, they did not find widespread acceptance. [1] There were concerns in the surgeon community regarding postoperative complications due to adhesions, the time it took to complete the procedure, and the ability to clearly identify the target tissue.

One of the limitations of the original efforts at thermal ablation of fibroids was that the surgeon was not able to determine the extent of the ablation during the procedure. People realized that creating multiple ablation sites within a fibroid would maximize the ablation volume. However, attempting to perform multiple insertions of a needle electrode would be time consuming and would create adhesions in the patient, as well as potentially introduce other potential complications.

Recent developments of RF platforms, such as the Acessa™ System, have helped address these concerns. The Acessa Handpiece incorporates an electrode array with which a controlled zone of ablation is created. The size of the ablation is dependent on the size of the fibroid. Additionally, the procedure incorporates the use of both a laparoscope and laparoscopic ultrasound for visualization and guidance during the procedure. Both contribute to the ability of the surgeon to effectively identify and treat most fibroids present during a procedure.

[1] S. Jones et al, Radiofrequency Ablation for Treatment of Symptomatic Uterine Fibroids, Obstetrics and Gynecology International, Volume 2012.