Ultraschall Med 2012; 33(7): E8-E15
DOI: 10.1055/s-0031-1299407
Review
© Georg Thieme Verlag KG Stuttgart · New York

High-Intensity Focused Ultrasound in Obstetrics and Gynecology: The Birth of a New Era of Noninvasive Surgery?

Hochintensiv fokussierter Ultraschall in Gynäkologie und Geburtshilfe: Beginn einer neuen Ära der nicht invasiven Chirurgie?
A. Griffiths
1   School of Clinical Medicine, University of Cambridge
,
G. terHaar
2   Physics, Institute of Cancer Research
,
I. Rivens
2   Physics, Institute of Cancer Research
,
D. Giussani
3   Department of Physiology Development & Neuroscience, University of Cambridge
,
C. Lees
4   Rosie Maternity Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust
› Author Affiliations
Further Information

Publication History

01 December 2011

15 February 2012

Publication Date:
21 June 2012 (online)

Abstract

Although ultrasound is an essential investigative modality in obstetrics and gynecology, the potential for therapeutic high-intensity focused ultrasound (HIFU) (also referred to as focused ultrasound surgery, FUS) to offer an alternative to invasive surgery is less well known. The ability of HIFU to create discrete regions of tissue necrosis only in precisely targeted positions by careful placement of the focus, without the need for any surgical intervention, has made HIFU of interest to those seeking noninvasive alternatives to conventional abdominal surgery. This article reviews the current experimental and clinical experience with HIFU in obstetrics and gynecology, and outlines potential future applications in fetal medicine and the challenges faced in their development.

Zusammenfassung

Obwohl die Sonografie ein bedeutendes diagnostisches Mittel in Gynäkologie und Geburtshilfe darstellt, ist der therapeutische hochintensiv fokussierte Ultraschall (HIFU) (auch als fokussierte Ultraschallchirurgie, FUS bezeichnet), der eine mögliche Alternative zur invasiven Chirurgie darstellt, weniger gut bekannt. Der HIFU hat das Interesse derer geweckt, die nicht invasive Alternativen zur herkömmlichen Bauchchirurgie suchen, da er in der Lage ist, nur in genau gerichteten Positionen durch vorsichtige Platzierung des Fokus den Gewebstod in abgegrenzten Bereichen hervorzurufen, ohne dass eine chirurgische Intervention nötig ist. Dieser Beitrag bespricht die aktuellen experimentellen und klinischen Erfahrungen mit HIFU in der Gynäkologie und Geburtshilfe und gibt einen Überblick über mögliche zukünftige Anwendungen in der fetalen Medizin und den bei der Entwicklung auftretenden Anforderungen.

 
  • References

  • 1 Wu F, Chen WZ, Bai J et al. Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound in Medicine and Biology 2001; 27: 1099-1106
  • 2 Madersbacher S, Marberger M. Tissue ablation by high-intensity focused ultrasound in benign prostatic hypertrophy. J Urol 1993; 99: 349
  • 3 Vaezy S, Zderic V. Hemorrhage control using high intensity focused ultrasound. Int J Hyperthermia 2007; 23: 203-211
  • 4 Hill CR, ter Haar GR. Review article: high intensity focused ultrasound – potential for cancer treatment. Br J Radiol 1995; 68: 1296-1303
  • 5 Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys 1984; 10: 787-800
  • 6 Watkin NA, ter Haar GR, Rivens I. The intensity dependence of the site of maximal energy deposition in focused ultrasound surgery. Ultrasound Med Biol 1996; 22: 483-491
  • 7 Moussatov AG, Baker AC, Duck FA. A possible approach to the treatment of polycystic ovarian syndrome using focused ultrasound. Ultrasonics 1998; 36: 893-900
  • 8 Vaezy S, Fujimoto VY, Walker C et al. Treatment of uterine fibroid tumors in a nude mouse model using high-intensity focused ultrasound. Am J Obstet Gynecol 2000; 183: 6-11
  • 9 Keshavarzi A, Vaezy S, Noble ML et al. Treatment of uterine fibroid tumors in an in situ rat model using high-intensity focused ultrasound. Fertil Steril 2003; 80: 761-767
  • 10 Keshavarzi A, Vaezy S, Noble ML et al. Treatment of uterine leiomyosarcoma in a xenograft nude mouse model using high-intensity focused ultrasound: a potential treatment modality for recurrent pelvic disease. Gynecol Oncol 2002; 86: 344-350
  • 11 Wu R, Hu B, Jiang LX et al. High-intensity focused ultrasound in ovarian cancer xenografts. Adv Ther 2008; 25: 810-819
  • 12 Paek B, Foley J, Zderic V et al. Selective reduction of multifetal pregnancy using high-intensity focused ultrasound in the rabbit model. Ultrasound Obstet Gynecol 2005; 26: 267-270
  • 13 Ichizuka K, Ando S, Ichihara M et al. Application of high-intensity focused ultrasound for umbilical artery occlusion in a rabbit model. Ultrasound Obstet Gynecol 2007; 30: 47-51
  • 14 Paek BW, Vaezy S, Fujimoto V et al. Tissue ablation using high-intensity focused ultrasound in the fetal sheep model: potential for fetal treatment. Am J Obstet Gynecol 2003; 189: 702-705
  • 15 Denbow ML, Rivens IH, Rowland IJ et al. Preclinical development of noninvasive vascular occlusion with focused ultrasonic surgery for fetal therapy. Am J Obstet Gynecol 2000; 182: 387-392
  • 16 Rivens IH, Rowland IJ, Denbow M et al. Vascular occlusion using focused ultrasound surgery for use in fetal medicine. Eur J Ultrasound 1999; 9: 89-97
  • 17 Nizard J, Pessel M, De Keersmaecker B et al. High-intensity focused ultrasound in the treatment of postpartum hemorrhage: an animal model. Ultrasound Obstet Gynecol 2004; 23: 262-266
  • 18 Fujisaki M, Chiba T, Enosawa S et al. Cardiac intervention using high-intensity focused ultrasound: creation of interatrial communication in beating heart of an anesthetized rabbit. Ultrasound Obstet Gynecol 2010; 36: 607-612
  • 19 Chen J, Zhou D, Liu Y et al. A comparison between ultrasound therapy and laser therapy for symptomatic cervical ectopy. Ultrasound Med Biol 2008; 34: 1770-1774
  • 20 Zhou M, Chen JY, Tang LD et al. Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center. Fertil Steril 2011; 95: 900-905
  • 21 Ruan L, Xie Z, Wang H et al. High-intensity focused ultrasound treatment for non-neoplastic epithelial disorders of the vulva. Int J Gynaecol Obstet 2010; 109: 167-170
  • 22 Wang Y, Wang W, Wang L et al. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: Preliminary results. Eur J Radiol 2010;
  • 23 Tempany CM, Stewart EA, McDannold N et al. MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology 2003; 226: 897-905
  • 24 Leon-Villapalos J, Kaniorou-Larai M, Dziewulski P. Full thickness abdominal burn following magnetic resonance guided focused ultrasound therapy. Burns 2005; 31: 1054-1055
  • 25 Smart OC, Hindley JT, Regan L et al. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol 2006; 108: 49-54
  • 26 Hindley J, Gedroyc WM, Regan L et al. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. Am J Roentgenol 2004; 183: 1713-1719
  • 27 Spies JB, Coyne K, Guaou Guaou N et al. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 2002; 99: 290-300
  • 28 Stewart EA, Rabinovici J, Tempany CM et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 2006; 85: 22-29
  • 29 Okada A, Morita Y, Fukunishi H et al. Non-invasive magnetic resonance-guided focused ultrasound treatment of uterine fibroids in a large Japanese population: impact of the learning curve on patient outcome. Ultrasound Obstet Gynecol 2009; 34: 579-583
  • 30 Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol 2009; 34: 584-589
  • 31 Stewart EA, Gostout B, Rabinovici J et al. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007; 110: 279-287
  • 32 Zaher S, Gedroyc WM, Regan L. Patient suitability for magnetic resonance guided focused ultrasound surgery of uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2009; 143: 98-102
  • 33 Rabinovici J, David M, Fukunishi H et al. Pregnancy outcome after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids. Fertil Steril 2010; 93: 199-209
  • 34 Hanstede MM, Tempany CM, Stewart EA. Focused ultrasound surgery of intramural leiomyomas may facilitate fertility: a case report. Fertil Steril 2007; 88: 497.e5-497.e7
  • 35 Taran FA, Tempany CM, Regan L et al. Magnetic resonance-guided focused ultrasound (MRgFUS) compared with abdominal hysterectomy for treatment of uterine leiomyomas. Ultrasound Obstet Gynecol 2009; 34: 572-578
  • 36 Funaki K, Fukunishi H, Funaki T et al. Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images. Am J Obstet Gynecol 2007; 196: 184.e1-184.e6
  • 37 Oguchi O, Mori A, Kobayashi Y et al. Prediction of histopathologic features and proliferative activity of uterine leiomyoma by magnetic resonance imaging prior to GnRH analogue therapy: correlation between T2-weighted images and effect of GnRH analogue. J Obstet Gynaecol 1995; 21: 107-117
  • 38 deSouza NM, Williams AD. Uterine arterial embolization for leiomyomas: perfusion and volume changes at MR imaging and relation to clinical outcome. Radiology 2002; 222: 367-374
  • 39 Yoon SW, Kim KA, Cha SH et al. Successful use of magnetic resonance-guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis. Fertil Steril 2008; 90: 2018.e13-2018.e15
  • 40 Yang Z, Cao YD, Hu LN et al. Feasibility of laparoscopic high-intensity focused ultrasound treatment for patients with uterine localized adenomyosis. Fertil Steril 2009; 91: 2338-2343
  • 41 Kim KA, Yoon SW, Lee C et al. Short-term results of magnetic resonance imaging-guided focused ultrasound surgery for patients with adenomyosis: symptomatic relief and pain reduction. Fertil Steril 2011; 95: 1152-1155
  • 42 Li CZ, Wang ZB, Yang X et al. Feasibility of focused ultrasound therapy for recurrent cervicitis with high-risk human papillomavirus infection. Ultrasound Obstet Gynecol 2009; 34: 590-594
  • 43 Li C, Bian D, Chen W et al. Focused ultrasound therapy of vulvar dystrophies: a feasibility study. Obstet Gynecol 2004; 104: 915-921
  • 44 Tan TY, Sepulveda W. Acardiac twin: a systematic review of minimally invasive treatment modalities. Ultrasound Obstet Gynecol 2003; 22: 409-419
  • 45 Quintero RA, Chmait RH, Murakoshi T et al. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol 2006; 194: 982-991
  • 46 Hedrick HL, Flake AW, Crombleholme TM et al. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg 2004; 39: 430-438 ; discussion 430-8
  • 47 Bond SJ, Harrison MR, Schmidt KG et al. Death due to high-output cardiac failure in fetal sacrococcygeal teratoma. J Pediatr Surg 1990; 25: 1287-1291
  • 48 Paek BW, Jennings RW, Harrison MR et al. Radiofrequency ablation of human fetal sacrococcygeal teratoma. Am J Obstet Gynecol 2001; 184: 503-507
  • 49 Lee LA, Simon C, Bove EL et al. High intensity focused ultrasound effect on cardiac tissues: potential for clinical application. Echocardiography 2000; 17: 563-566
  • 50 Xu Z, Ludomirsky A, Eun LY et al. Controlled ultrasound tissue erosion. IEEE Trans Ultrason Ferroelectr Freq Control 2004; 51: 726-736
  • 51 Ville Y, Hyett J, Hecher K et al. Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 1995; 332: 224-227
  • 52 Deprest JA, Van Schoubroeck D, Van Ballaer PP et al. Alternative technique for Nd: YAG laser coagulation in twin-to-twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol 1998; 11: 347-352
  • 53 Denbow ML, Taylor M, Cox P et al. Derivation of rate of arterio-arterial anastomotic transfusion between monochorionic twin fetuses by Doppler waveform analysis. Placenta 2004; 25: 664-670