Radio Frequency Ablation of Fibroids allowing Uterine and Ovarian Conservation
The Acessa® procedure is recommended for pre-menopausal women (typically younger than 55 years old)1 who are tired of living with the ongoing pain and discomfort of fibroids and are looking for a minimally invasive option that allows them to keep their uterus and return to daily life quickly after the procedure.1 The Acessa® procedure is also known as Laparoscopic Radiofrequency Ablation (LAP-RFA) and essentially delivers heat directly into a fibroid in order to destroy its tissue and in turn relieve your symptoms. All treatment options for intrauterine pathologies have benefits, warnings, precautions, and risks. Before making a treatment decision, you should discuss these with your doctor. Rare but serious risks include, but are not limited to, skin burns, mild inter-operative bleeding, post-procedural discomfort (cramping, pelvic pain), infection, vaginal bleeding, blood loss and complications related to laparoscopy and or general anesthesia.
What are Fibroids?
Fibroids are tumors which develop in the uterus and are made up of smooth muscle cells and fibrous connective tissue. Although 70-80% of women may develop fibroids (UCLA Health, 2021), not everyone will develop symptoms or require treatment. Symptoms may include heavy or prolonged periods, lower back pain, difficulty getting pregnant, frequent urination, pelvic pain and bleeding between periods. Women nearing menopause face the greatest susceptibility of developing fibroids. While the cause of uterine fibroids remains unknown, there are various factors that can contribute to the risk of developing uterine fibroids such as age, family history, ethnic origin and obesity. Complications of not treating uterine fibroids can lead to anemia due to heavy bleeding, infertility or kidney damage. It is important if you are experiencing symptoms that you refer to your health care provider to explore treatment options.
How does Acessa compare to other common fibroid treatment options?
Vs. Hysterectomy
The Acessa procedure allows you to keep your uterus and has a quicker recovery time than a hysterectomy. However, hysterectomy is a definitive treatment, so after recovery, there is no chance fibroid symptoms will return.
Vs. Myomectomy
Myomectomy cuts fibroids and surgically removes fibroid tissues from the uterus. The Acessa procedure, by comparison, does not require cutting or suturing within the uterus.2 Myomectomy may be considered a minimally invasive surgery because incisions into the abdomen can be small. The Acessa procedure may be a less invasive option because there are zero incisions on the uterine surface (serosa) that require suturing, and only 3 small incisions on the skin (myomectomy typically requires 4 to 6 incisions in the skin).
Vs. UAE
UAE involves ischemic necrosis which consists of the tissue slowly dying due to lack of blood supply and typically involves an overnight stay for pain management.3 The Acessa procedure uses coagulative necrosis which destroys the fibroid cells and nerve endings with heat and results in the reduction of the fibroid volume over time.1,4 After the Acessa procedure, patients typically return home the same day. UAE is performed by interventional radiologists. The Acessa procedure is performed by minimally invasive gynecologic surgeons.
Symptoms Treated by the Acessa® Procedure
The Acessa® Procedure
The Acessa® procedure is also known as Laparoscopic Radiofrequency Ablation (LAP-RFA) and essentially delivers heat directly into a fibroid in order to destroy its tissue and in turn relieve your symptoms. The procedure contains 6 steps:
1. Prep – You are prepped and brought into the operating room for anesthesia.
2. Access – Your physician makes three small incisions-one in your belly button - one below your bikini line - and inserts a tiny camera and ultrasound into each incision.
3. Visualize – Your Physician precisely located each fibroid with the Acessa ultrasound probe and guidance mapping, allowing full view of your uterus.
4. Deploy – Next, your physician deploys the tip of the Acessa handpiece into the fibroid while preserving healthy uterine tissue.
5. Treat – The physician deploys controlled heat through the Acessa handpiece to destroy the fibroid tissue. The physician repeats this process until every targeted fibroid is fully treated. Once the procedure is complete, your physician stitches the small incisions on the skin.
6. Recover – You will wake up in the recovery room. Most patients get cleared to go home within two hours. Women typically feel ready to return to work and daily activities after 4-5 days. In terms of when you will see symptom relief – this is a hot topic. It depends on how big the fibroid is and what symptoms you’re experiencing.
How does Acessa work?
1. The clinical terminology for the procedure is Laparoscopic radiofrequency ablation (Lap-RFA) for fibroids.
2. The Acessa procedure is an outpatient procedure, and patients generally go home the same day, on NSAIDS.1
3. The Acessa procedure works by heating the fibroid cells using radiofrequency ablation. The treated fibroid cell shrinks overtime, ultimately resolving fibroid symptoms.1
4. After the fibroid is treated, the consistency of the fibroid tissue changes. Imagine a hard baseball turning into a soft marshmallow.
5. The Acessa procedure is performed laparoscopically through small incisions in the abdomen.
6. The Procedure has an ultrasound probe and allows for the use of a camera, which helps physicians visualize fibroids.
7. The Acessa procedure typically takes between 90-120 minutes depending on size, location and number of fibroids.
8. Fibroids are heated, using radiofrequency ablation to the point where they are destroyed and are no longer the consistency of a fibroid. The heat denatures the proteins inside the fibroids cells.
9. As a result, the change in consistency and gradual decrease in volume is what creates relief from fibroid symptoms which typically are reduced or go away as the fibroid shrinks overtime.
10. Women typically see the most improvement within 3-6 months with continued improvement throughout the first year.
11. Different symptoms resolve at different rates; some may resolve faster or slower than others.
12. There is no incision within the uterus which allows the physician to spare the healthy tissue.
13. The Acessa procedure can be used in conjunction with other procedures such as myomectomy or endometrial ablation
Size and location of fibroids are important factors in what procedure is right for you. That’s why physicians do an MRI or ultrasound prior to determining if you are a candidate for the procedure. The Acessa procedure has been studied on fibroids up to 7CM,.2 The procedure can be used to treat most types of symptomatic fibroids, including subserosal, intramural, transmural, and certain submucosal.1
The Results
- 94% of patients responded that the treatment had been somewhat, moderately, or very effective in eliminating their symptoms.1
- Only 11% of patients required additional reintervention after the Acessa procedure.1
- 98% reported that they would probably or definitely recommend the procedure to their friends with the same health problem.1
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1. Mayo Clinic—Uterine Fibroids—www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
2. The Acessa procedure ProVu Instructions for Use, ProVu Users Guide PL-01-0040
