Bruce Farringer, MD FACOG
Sierra Women’s Health, Reno NV
January 3, 2022
Sierra Women’s Health and Dr. Farringer are pleased to begin offering a new uterine-sparing treatment for severely-symptomatic uterine fibroids, Laparoscopic Radiofrequency Ablation (LAP-RFA) with the Acessa system made by Hologic. This is an outpatient surgery using 3 small abdominal incisions (one of them very small), laparoscopic ultrasound to map the fibroids, and a device inserted right into the middle of the fibroids to cause coagulative necrosis (IE kill fibroid tissue with intense heat, 95*C). Studies have shown that LAP-RFA is very likely to improve quality of life, reduce uterine bleeding, and reduce uterine size and the associated bulk symptoms (pain, pressure etc.) Thus far, only 11% of women who’ve undergone LAP-RFA with Acessa have needed another intervention for fibroids within 3 years. Hologic has a cool website, https://gynsurgicalsolutions.com. Go to the website, click “For Patients”, and you can learn all about Acessa LAP-RFA as well as 2 other devices that we’ve used extensively in our surgical practice (NovaSure and MyoSure).
Fibroids are very common benign growths in the uterine muscle, present in at least 50% of women. Many women have small or symptom-free fibroids that don’t require any treatment at all. Some women have large fibroids or severely symptomatic fibroids, and desire treatment. Fibroid symptoms can include excessive bleeding, pain, pressure, sexual dysfunction, abdominal distention or bloating, or symptoms arising from surrounding organs like the bladder, rectum, or intestines. The only definitive, permanent cure for fibroids is hysterectomy, removal of the uterus. That is obviously not an option for women who desire future pregnancy, and many women simply don’t want their uterus removed.
Some medicines (oral contraceptives, hormone-releasing IUD, tranexamic acid, GnRH antagonists) can reduce heavy bleeding that is sometimes associated with fibroids, but medical therapy is unlikely to reduce the size of fibroids or have any long-term improvement in the other symptoms caused by fibroids. One medicine (GnRH agonist) is sometimes used to shrink fibroids in anticipation of a planned hysterectomy but does not permanently shrink them.
Non-medical, uterine-sparing procedures for treating fibroids include laparoscopic myomectomy (carving fibroids out of the uterus and sewing the uterus back together), hysteroscopic myomectomy (shaving fibroids out of the uterine cavity with Hologic’s MyoSure device), and uterine artery embolization (an Interventional Radiology procedure that aims to obstruct the uterine arteries via a catheter inserted into the groin vessels). NovaSure radiofrequency endometrial ablation could reduce bleeding from fibroids, but only if they’re small and right under the endometrial lining.
Acessa LAP-RFA is now another option for uterine-sparing treatment of fibroids. It is real surgery, but a little less “invasive” than myomectomy (ie no sewed-up incisions in the uterine muscle). Acessa LAP-RFA can be done as a stand-alone procedure or can be combined with laparoscopic myomectomy or other laparoscopic procedures like sterilization or treatment of endometriosis.
Our professional society, the American College of Obstetricians and Gynecologists, stated in June 2021 that “Although LAP-RFA is a reasonable option to consider for the treatment of symptomatic uterine leiomyomas (fibroids), access to this technology is currently limited.” Hologic is committed to improving access to LAP-RFA. Dr. Farringer has completed Acessa training, and spent a wonderful day in Austin learning from two of our profession’s preeminent Gynecologic surgeons, including direct observation in the O.R.
The Acessa device and LAP-RFA is not yet in Reno. Nobody in Reno appears in the Acessa “Find a Physician” page on the website because it’s not here yet. When we find several patients who need the procedure, we are confident that Hologic will supply Renown Roseview Outpatient Surgery Center with the equipment and staff-training. For our first day of Acessa procedures, a highly experienced mentor will fly in for the day and observe our surgeries in person. After we’ve done quite a few Acessa procedures we hope to become mentors for other surgeons learning the procedure.
Not everybody with fibroids is a candidate for Acessa. An MRI imaging study is essential to determine if fibroids are amenable to Acessa ablation. Most of them are. If you feel you’re interested in this uterine-sparing option for symptomatic uterine fibroids, Dr. Farringer would love to see you for a consultation.