Rad-13. Percutaneous cryosurgery for uterine fibroids with interventional magnetic resonance guidance and monitoring.

Uterine fibroids affect approximately 65% of women over age 45. They are a large source of morbidity in the United States and throughout the world. The predominant treatment is hysterectomy. About 600,000 hysterectomies are performed annually in the United States. Our goal was to define and develop a minimally invasive procedure to treat large symptomatic uterine fibroids. After establishing an Investigational Review Board protocol, women are selected on the basis of symptoms related to large uterine fibroids (bleeding, uterine pain, bladder compression, stress incontinence and pelvic congestion). To date, 14 women have been enrolled. All women denied any desire for future child bearing. Physical examination was performed followed by diagnostic MRI to determine the anatomy of the uterus and the amount of fibroid burden. Patients were treated via a percutaneous approach using an Argon gas cryo system (Galil USA). A Signa LS Interventional vertical donut open IMRI (GE, USA) was used to monitor probe position and to monitor the development of the ice ball. A follow-up MRI was obtained at 8 to 10 weeks to determine the volume reduction of the lesion. Clinical evaluation was used to assess reduction of clinical symptoms and detect subacute complications. Clinical evaluation post-cryo revealed a mild syndrome of pain that required non-steroidal anti-inflammatory drugs but no narcotics. The pain typically began between 5 and 14 days after the procedure. On imaging studies, reduction of volume ranged between 33 and 88% with a mean of 60%. Two major complications were noted (1) a small bowel perforation was discovered and repaired during exploratory laparotomy at post op day 4, and (2) mild left foot drop from probe overpenetration, which largely resolved with time. Preliminary results suggest that this procedure is highly effective at accomplishing a large volume reduction of symptomatic uterine fibroids.

Patrick E. Sewell, Jr, MD, Brian D. Cowan, MD, Pam Gressett, RN, and Nancy Thomas, NP, RN. University of Mississippi Medical School, Departments of Radiology and OB-GYN, Jackson MI.