ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.
ExAblate FAQs
What is the ExAblate 2000 treatment?
It is a only non-invasive surgical procedure that has been approved by the FDA to treat uterine fibroids using focused ultrasound. Ultrasound waves are high frequency sound waves that the human ear cannot hear. When they are focused, similar to how a magnifying glass focuses light waves, heating of fibroid tissue occurs at the focus. The ExAblate device uses MR images to allow the doctor to see inside your body and locate where the fibroid is. During the treatment, MR images allow the doctor to see what temperatures the fibroid has reached, and after treatment, MR images allow the doctor to see how successful the treatment has been.
I think I might have fibroids – how can I tell?
Only your physician can diagnose fibroids. If you are experiencing any of the following symptoms of fibroids, you may wish to speak with him or her:
- Very heavy and prolonged monthly periods, sometimes with clots
- Pain in the back or in the legs
- Pelvic pain or pressure
- Pain during sexual intercourse
- Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to empty the bladder
- Pressure on the bowel which can lead to constipation and/or bloating
- An enlarged abdomen which may be mistaken for weight gain or pregnancy
How will my physician tell if I have fibroids?
During your gynecological examination, your doctor will check the size of your uterus. If it feels enlarged, your doctor may order an abdominal or transvaginal ultrasound or a magnetic resonance (MR) imaging session, which can confirm the presence, location and size of fibroids. After identifying the size and location of your fibroids, and possibly after other diagnostic tests, your doctor may be able to rule out other conditions, advise you of your options and recommend a course of treatment for fibroids.
What types of fibroids can be treated with the ExAblate 2000?
Your physician will determine if your fibroids are suitable for treatment. ExAblate can be used for submucosal, subserosal, and intramural uterine fibroids. These are terms that are used to describe the location of the fibroid within the uterus. More than one fibroid can be treated. Fibroids that are pedunculated (hanging from a stalk), in close proximity to sensitive organs (such as bowel or bladder), or in a location inaccessible by the focused ultrasound may be untreatable.
What is the treatment like?
The entire procedure takes place with you lying in an MR scanner. The doctor will first take some MR images of your pelvic area to locate your uterus and your fibroid(s). Then, he will use these images to develop a treatment plan. When the treatment begins, a small beam of focused ultrasound is directed at the target for approximately 15 seconds and heats the tissue. MR images are taken during each heating cycle provide an image of the target tissue and the degree of heating. The system then moves to the next treatment point, and the process is repeated about once every 90 seconds until the entire volume has been treated. Typically, 30-100 individual pulses are delivered over a 3-hour period to complete a treatment. After the treatment, more MR images are taken to determine how successful the treatment was.
What will I be required to do during the treatment?
In order to have a successful treatment, it will be very important that you lie very still during the procedure. The doctor will give you some sedatives and pain medication to help you relax. The doctor also will talk with you throughout the procedure to see how you are feeling. You will be able to talk to the doctor and tell him or her if something is bothering you.
How long will the treatment last?
You will lie on the patient table inside an MRI for 3-4 hours depending on the size of your fibroid(s).
What will I feel during the treatment?
Women have reported feeling a warming sensation on their skin or inside the pelvic region. You may feel a 'pinch' or something like a brief menstrual cramp when the energy is being delivered. During the treatment, the doctor will advise you of sensations that are normal and instruct you to stop the treatment if you experience sensations that are not normal, using a button that you will hold in your hand.
What happens to me after the treatment?
The ExAblate treatment is performed as an outpatient procedure that takes 3-4 hours. Following the treatment you will rest for additional 1-2 hours.
Based on how you are feeling, you will receive discharge instructions from your doctor regarding medications you may need to take to keep you comfortable. Usually, over-the-counter pain relief medication is all that is required. You may experience some cramping, similar to menstrual period cramping; or shoulder or back pain that lasts a few days after the procedure from lying in the treatment position.
Most women are able to return to work and normal activity within 1-2 days.
Who provides my post-procedural care / what will I need to do after the treatment?
It is important that you and your doctor discuss who will handle your follow-up care, phone calls and/or office visits, after the procedure. You should also know who to contact in case of an emergency after your procedure. This is especially important if you are experiencing fever, pelvic pain, or foul-smelling vaginal discharge after the procedure that increases over time and lasts more than 24 hours.
How soon will I start to feel better?
Depending on initial symptoms, most patients find relief in their fibroid-related symptoms within 3 months, as shown by a clinical study conducted by InSightec.
I recently had a myomectomy but my fibroids are still bothering me – can I get this treatment?
Your doctor would be the best person to talk to about this. Depending on how the surgery was performed, patients that have scar tissue on their abdomen from myomectomy or a previous surgery/C-section may not be eligible for the treatment since focused ultrasound may cause heating or skin burns when large scar tissue is present.
I previously had a Uterine Artery Embolization/Uterine Fibroid Embolization – can I still get this treatment?
Uterine Artery Embolization involves the injection of microbeads made of poly-vinyl alcohol or other materials that block the small vessels of the fibroid and uterus. There were no patients with previous UFE/UAE treatment in the previous clinical studies, and the risks are unknown at this time.
What should I tell my doctor about my health before this treatment?
Before you undergo ExAblate treatment you should discuss:
- Your personal health history, including any allergies you may have
- Your families health history
- Any recent illnesses
- Medicines, include both prescription, over the counter and herbal medicines or dietary supplements
- Recent activities, including travel
- Your level of normal physical activity
- Previous MR or CT imaging studies
What are my other treatment alternatives?
Your physician would be the best person to discuss treatment alternatives with you. Other available treatments are:
- Watchful waiting
- Hysterectomy
- Abdominal myomectomy
- Laparoscopic or hysteroscopic myomectomy
- Uterine artery embolization
- Hormone Therapy
Could my fibroids come back after the treatment?
Although this treatment may be successful in destroying the fibroids causing painful symptoms, at a later time, more fibroids may grow, become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed. In the clinical trial, 21% of the subjects had alternative surgical treatment for their fibroids within 1 year of the treatment with ExAblate.
Are there any risks to the treatment?
As with any medical procedure, there are risks involved in the ExAblate treatment. Your physician would be the best person to talk to about this.
What other tumors are being treated using ExAblate 2000?
Clinical trials for verifying the safety and efficacy of the MRgFUS technology (or ExAblate) are being conducted for, bone metastases, breast cancer, brain tumors, liver and prostate cancer. For more information please check the InSightec website. (www.insightec.com)
How many patients have been treated so far?
Over 3,500 patients have been treated in the US and around the world.
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