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Minimally Invasive Procedure Offers an Option to Hysterectomy

November 18, 2009

                  Interventional Radiologist Discusses Treatment Options for Uterine Fibroids

As medical technology advances, it often brings with it exciting news. For many patients seeking treatment today, there are better options in the form of minimally invasive procedures that are now available.

Minimally invasive means just what it sounds like. As little invasion of the body as possible. And that’s what Dr. Bruce Lin, Washington Hospital Medical Staff interventional radiologist (IR), is offering to women seeking treatment for uterine leiomyomas, also called uterine fibroids.

Fibroids, which are benign tumors of the uterus, can grow as large as 20 centimeters – or about eight inches, but most women may not even know they have them.

"Many fibroids are not symptomatic," Dr. Lin explains. "As much as 90 percent of overall fibroids do not cause significant symptoms. Most women present with heavy bleeding or menses, called menorrhagia, and some may even become anemic due to excessive bleeding."

For women experiencing symptoms of uterine fibroids, treatment can significantly improve quality of life.

"Many symptomatic women have discomfort, pain, and pressure in the pelvis, the back and even the legs. Some may experience pain during sexual intercourse. There are also symptoms due to enlargement of the uterus from large fibroids; these include urinary frequency due to the enlarged uterus pressing on the bladder, and constipation from the pressure on the intestine."

As an interventional radiologist (IR), Dr. Lin represents a subset of physicians specializing in minimally invasive treatments throughout the body using imaging guidance like flouroscopy, CT and ultrasound.

"We work with micro-tools especially developed for these procedures to perform treatments that were traditionally accomplished with open surgery," Dr. Lin says. "IRs undergo more sub-specialized training after diagnostic radiology to master basic and advanced interventional procedures and obtain further certification in this subspecialty."

Previously, the standard option for women needing treatment for uterine fibroids was surgical removal of the uterus, known as a hysterectomy. Dr. Lin’s advanced training offers women in the Tri-City area another alternative.

Embolization is a non-surgical, minimally invasive procedure that involves the intentional occlusion or blockage of the blood vessels feeding the fibroid by introducing an object that impedes blood flow to the growth.

"Once the fibroids are deprived of normal blood supply and the oxygen and nutrients carried by it, they will undergo degeneration and begin to shrink," Dr. Lin says. 

The result?

"Studies have shown that at three to five months after the procedure, the average reduction of fibroid volume is at least 60 percent and uterine volume can decrease by a similar percentage," Dr. Lin reveals. "Approximately 85 to 95 percent of our patients see positive improvements."

Dr. Lin cites data collected by the Fibroid Registry for Outcomes Data (FIBROID) showing that a three-year follow up indicates durable and excellent results. Patient satisfaction, according to studies published by the Society of Interventional Radiology (SIR – www.sirweb.org) and Radiological Society of North America (RSNA), has also been very high for the procedure.

And what does this mean for the patient? A great deal, according to Dr. Lin.

"Minimally invasive procedures minimize the risks, such as morbidity and mortality, associated with the more invasive surgical alternatives," he says. "Also, because the procedure is performed through small punctures or incisions, the recovery time is much shorter than the surgical alternatives.

"Patients are able to return to normal routine and work sooner and feel better in a shorter period of time. Frequently, minimally invasive procedures are also less costly to the patient and the medical system."

Uterine fibroid embolization (UFE), according to Dr. Lin, represents a highly effective uterus-conserving therapy for treatment of fibroids. Since the treatment requires minimal incisions, patients experience almost no blood loss, allowing them to return their daily lives much faster.

"Now women who do not wish to undergo a hysterectomy for their fibroid problems have a viable alternative," he says.

The UFE procedure has been performed since the mid-1990s, and, according to Dr. Lin, the technique has advanced tremendously and the outcome data has been validated by many studies.

"UFE is now considered a level A treatment option to hysterectomy for fibroids by the American College of Obstetricians and Gynecologists (ACOG)," Dr. Lin notes.

Dr. Lin, who has been performing the procedure since 2000, says the most important element of the procedure is that patients’ quality of life is vastly improved with minimal recovery time.

To find out more about services and programs offered at Washington Hospital, visit www.whhs.com.

About Uterine Fibroid Embolization

Before performing the uterine fibroid embolization procedure, a baseline magnetic resonance imaging (MRI) of the pelvis is necessary to characterize the fibroids, their numbers, locations and sizes.

Once the MRI is completed, a preliminary consultation with an interventional radiologist (IR) is conducted to answer a patient’s questions and assess whether or not the patient is a good candidate for UFE based on the symptoms and the MRI findings.

After treatment, patients are monitored by MRI to assess for viability of the fibroids, shrinkage of fibroids and uterus, and necessity for re-intervention.

Following the procedure, patients are admitted overnight for pain control and observation. Most patients are discharged home the next day with pain medications and antibiotics and are able to resume work or normal schedule in one to two weeks with few exceptions.

For more information about Uterine Fibroid Embolization or other interventional radiology procedures, contact Washington Hospital’s Interventional Radiology (IR) Service Coordinator at (510) 608-1362 or visit www.whhs.com/interventionalradiology