Vol 94, No 5 (2023)
Research paper
Published online: 2022-05-30

open access

Page views 2096
Article views/downloads 524
Get Citation

Connect on Social Media

Connect on Social Media

A contrastive study on the clinical efficacy and safety oflaparoscopic myomectomy and high intensity focused ultrasound in the treatment of uterine fibroids

Yingqiang Ren1, Yutan Li1, Yuanfang Pu1
Pubmed: 35894494
Ginekol Pol 2023;94(5):358-365.


Objectives: This study intended to compare the safety and clinical efficacy between two treatments of uterine fibroids: laparoscopic myomectomy (LM) and high intensity focused ultrasound (HIFU).
Material and methods: Clinical data were collected from 587 uterine fibroid patients who were treated in The People’s Hospital of Nanchuan, Chongqing from January 1, 2018 to December 31, 2019. Among the patients, 287 cases were treated with HIFU (observation group), and 300 cases were treated with LM (control group). The progression-free survival (PFS) was taken as the primary endpoint. The secondary endpoints included operation results (including operative time, intraoperative blood loss, and intraoperative fluid replacement), complications, hemoglobin level one month after surgery and clinical efficacy. In addition, the fibroid volume of the observation group before treatment and 3, 6, and 12 months after treatment were also analyzed.
Results: The operative time of observation group was evidently shortened compared to the control group, and the intraoperative blood loss and intraoperative fluid replacement of observation group were also considerably reduced (all p < 0.05), but there was no significant difference in the hemoglobin level between the two groups one month after surgery (p > 0.05). In terms of curative effect, the total effective rate of HIFU group and LM group was 98.6% (283/287) and 95.3% (286/300) respectively, with statistically significant difference (p < 0.05). In terms of complications, the incidence of bleeding and infection in HIFU group was obviously lower than that in LM group (both p < 0.05), while no significant differences were observed in the remaining complications (all p > 0.05). Fibroid volume comparisons before treatment
and 3, 6 and 12 months after operation in observation group showed that fibroid volume decreased significantly (all p < 0.05). The median follow-up time was 30.6 months. The mean PFS of patients in the observation group and control group was 29.71 months (95% CI 28.24–29.75) and 26.74 months (95% CI 26.49–28.33), respectively (HR 0.47; 95% CI, 0.29 to 0.76; Log-rank p = 0.0019).
Conclusions: HIFU could improve the intraoperative efficacy and reduce the complications of patients with uterine fibroids and has excellent performance in improving clinical efficacy and prolonging PFS. HIFU can be used as an alternative to surgical treatment.

Article available in PDF format

View PDF Download PDF file


  1. Stewart EA, Laughlin-Tommaso SK, Catherino WH, et al. Uterine fibroids. Nat Rev Dis Primers. 2016; 2: 16043.
  2. Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas). BMJ Clin Evid. 2015; 2: 2015.
  3. Donnez J, Donnez O, Dolmans MM. With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice? Fertil Steril. 2014; 102(3): 640–648.
  4. Ali M, A R S, Al Hendy A. Elagolix in the treatment of heavy menstrual bleeding associated with uterine fibroids in premenopausal women. Expert Rev Clin Pharmacol. 2021; 14(4): 427–437.
  5. McWilliams MM, Chennathukuzhi VM. Recent advances in uterine fibroid etiology. Semin Reprod Med. 2017; 35(2): 181–189.
  6. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016; 22(6): 665–686.
  7. de la Cruz MSD, Buchanan EM. Uterine fibroids: diagnosis and treatment. Am Fam Physician. 2017; 95(2): 100–107.
  8. Brady PC, Stanic AK, Styer AK. Uterine fibroids and subfertility: an update on the role of myomectomy. Curr Opin Obstet Gynecol. 2013; 25(3): 255–259.
  9. Kotani Y, Tobiume T, Fujishima R, et al. Recurrence of uterine myoma after myomectomy: open myomectomy versus laparoscopic myomectomy. J Obstet Gynaecol Res. 2018; 44(2): 298–302.
  10. Jacoby VL, Kohi MP, Poder L, et al. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Fertil Steril. 2016; 105(3): 773–780.
  11. Zhang X, Landgraf L, Bailis N, et al. Image-Guided High-Intensity Focused Ultrasound, A Novel Application for Interventional Nuclear Medicine? J Nucl Med. 2021; 62(9): 1181–1188.
  12. Lee JY, Kim K, Hwang SIl, et al. Efficacy and safety of transvaginal high-intensity focused ultrasound therapy in women with symptomatic uterine leiomyomas: A clinical trial. Eur J Obstet Gynecol Reprod Biol. 2021; 256: 302–307.
  13. Zhang C, Jacobson H, Ngobese ZE, et al. Efficacy and safety of ultrasound-guided high intensity focused ultrasound ablation of symptomatic uterine fibroids in Black women: a preliminary study. BJOG. 2017; 124 Suppl 3: 12–17.
  14. Lyon PC, Rai V, Price N, et al. Ultrasound-Guided High Intensity Focused Ultrasound Ablation for Symptomatic Uterine Fibroids: Preliminary Clinical Experience. Ultraschall Med. 2020; 41(5): 550–556.
  15. Lee JY, Chung HH, Kang SY, et al. Portable ultrasound-guided high-intensity focused ultrasound with functions for safe and rapid ablation: prospective clinical trial for uterine fibroids-short-term and long-term results. Eur Radiol. 2020; 30(3): 1554–1563.
  16. Krzyzanowski J, Wozniak S, Szkodziak P, et al. Minimally invasive treatment options for uterine fibroids — state-of-the art 2021. Ginekologia Polska. 2022; 93(3): 242–247.
  17. Munro MG, Critchley HOD, Broder MS, et al. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011; 113(1): 3–13.
  18. Mindjuk I, Trumm CG, Herzog P, et al. MRI predictors of clinical success in MR-guided focused ultrasound (MRgFUS) treatments of uterine fibroids: results from a single centre. Eur Radiol. 2015; 25(5): 1317–1328.
  19. Spies J, Coyne K, Guaou NG, et al. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstetrics & Gynecology. 2002; 99(2): 290–300.
  20. Anneveldt KJ, van't Oever HJ, Nijholt IM, et al. Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids. Eur J Radiol. 2021; 141: 109801.
  21. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009; 91(4): 1215–1223.
  22. Milazzo GN, Catalano A, Badia V, et al. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017; 43(12): 1789–1804.
  23. Łoziński T, Filipowska J, Gurynowicz G, et al. Non-invasive therapeutic use of High-Intensity Focused Ultrasound (HIFU) with 3 Tesla Magnetic Resonance Imaging in women with symptomatic uterine fibroids. Ginekol Pol. 2017; 88(9): 497–503.
  24. Pavone D, Clemenza S, Sorbi F, et al. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018; 46: 3–11.
  25. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017; 11: CD000547.
  26. Jiang Z, Li Q, Li W, et al. A comparative analysis of pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound ablation and laparoscopic myomectomy: a retrospective study. Int J Hyperthermia. 2021; 38(1): 79–84.
  27. Wu G, Li R, He M, et al. A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: a comparative study. Int J Hyperthermia. 2020; 37(1): 617–623.
  28. Liu X, Tang J, Luo Y, et al. Comparison of high-intensity focused ultrasound ablation and secondary myomectomy for recurrent symptomatic uterine fibroids following myomectomy: a retrospective study. BJOG. 2020; 127(11): 1422–1428.
  29. Zhang Y, Sun Li, Guo Y, et al. The impact of preoperative gonadotropin-releasing hormone agonist treatment on women with uterine fibroids: a meta-analysis. Obstet Gynecol Surv. 2014; 69(2): 100–108.
  30. Asgari Z, Salehi F, Hoseini R, et al. Ultrasonographic features of uterine scar after laparoscopic and laparoscopy-assisted minilaparotomy myomectomy: a comparative study. J Minim Invasive Gynecol. 2020; 27(1): 148–154.
  31. Wang Yi, Wang ZB, Xu YH. Efficacy, efficiency, and safety of magnetic resonance-guided high-intensity focused ultrasound for ablation of uterine fibroids: comparison with ultrasound-guided method. Korean J Radiol. 2018; 19(4): 724–732.
  32. Siedek F, Yeo SY, Heijman E, et al. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU): technical background and overview of current clinical applications (part 1). Rofo. 2019; 191(6): 522–530.
  33. Gao H, Li T, Fu D, et al. Uterine artery embolization, surgery and high intensity focused ultrasound in the treatment of uterine fibroids: a network meta-analysis. Quant Imaging Med Surg. 2021; 11(9): 4125–4136.
  34. Wang Yi, Geng J, Bao H, et al. Comparative effectiveness and safety of high-intensity focused ultrasound for uterine fibroids: a systematic review and meta-analysis. Front Oncol. 2021; 11: 600800.