MR image-guided percutaneous laser ablation is used to treat uterine fibroids, also known as uterine leiomyomas or uterine myomas. Fibroids are benign tumours of the uterine muscle. They are very common and are often asymptomatic. They may cause abnormal bleeding, pelvic pressure and pain, and reproductive problems.
Hysterectomy is the standard treatment for women with fibroids whose symptoms have not resolved with medical treatment. However, in the past decade, there has been increased interest in minimally invasive surgical techniques.
Under MR-image guidance needles are inserted, through an area of skin that has been locally anaesthetised, into the centre of the targeted uterine fibroid. Bare laser fibres are inserted down the centre of each of the needles into the targeted fibroid. Laser energy is then used to destroy the fibroid.
A thermal mapping sequence is used to depict the extent of the heated tissue in the target area as the procedure is carried out.
A catheter is placed in the bladder before the start of the procedure and women receive intravenous sedation and analgesia throughout.
The evidence for efficacy was based on four reports published by 1 UK study group. Some women were included in more than 1 report. Limited evidence suggested that the procedure resulted in a short-term (3-month) reduction in fibroid volume of around 30%. For more details, see the overview.
The main comment from the Specialist Advisors related to the relatively new nature of the procedure. One Advisor commented on patient selection, stating that the procedure might only be appropriate for fibroids of a certain size, and that it might not be of benefit for women with larger or multiple fibroids.
Adverse events were reported in a minority of patients. Potential complications included urinary tract infections, skin burns and vaginal bleeding. These events were relatively minor and of a transitory nature. For more details, see the overview.
The Specialist Advisors listed the potential adverse effects as infection, burns, uterine damage and bowel or bladder damage.
This is a very specialised procedure and currently only 1 centre in the UK undertakes it. As such, the evidence available was limited.