Surgical treatments for uterine fibroids

Aakriti R. Carrubba, M.D. (Senior Associate Consultant, Obstetrics and Gynecology, Mayo Clinic in Florida): Hello, my name is Dr. Carrubba, and I'm one of the minimally invasive gynecologic surgeons at Mayo Clinic Florida. I see many patients with uterine fibroids, and I would like to spend a few minutes reviewing some of the new surgical treatment options, specifically fibroid radiofrequency ablation.

There are currently two FDA-approved products: Acessa and Sonata. Acessa is a laparoscopic-assisted device that uses an ultrasound probe to identify fibroids. Then a metallic device is inserted into individual fibroids which are directly heated with radiofrequency waves to induce coagulative necrosis. The fibroids shrink over time and reduce bleeding as well as bulk symptoms. Some surgeons perform this technique concurrently with a minimally invasive myomectomy to reach deeper fibroids that may be more difficult to remove. Recovery time is similar to myomectomy.

The Sonata procedure is a transcervical radiofrequency ablation that uses an ultrasound probe inside the uterus to identify fibroids. It can be performed in the office or in the operating room. Once the fibroids are identified, they are heated with radiofrequency waves using a similar metallic device.

There are safety measures used with both the Acessa and Sonata technologies to minimize thermal risk to surrounding tissue structures, like the bowel and bladder. The Sonata procedure has excellent recovery, as there are no abdominal incisions. And the fibroids tend to shrink by up to 50 percent over the following three months. It is important to note that neither Acessa nor Sonata are indicated for use in patients desiring pregnancy, due to lack of data. However, several women have had successful pregnancies after treatment.

At Mayo Clinic the Acessa procedure is currently offered at the Rochester, Minnesota, campus. And the Sonata procedure is offered in both Rochester and at the Jacksonville, Florida, campus. It is important to discuss the best surgical intervention with your doctor, as this may vary based on your age, fertility goals, size and location of fibroids, and medical comorbidities. If you are interested in discussing treatment options, please contact Mayo Clinic to schedule a consultation with our gynecology providers.