UFE vs. Acessa™: What Should I Opt For? 

A landmark study from the Journal of Women’s Health in 2013 (1) corroborated what many physicians who cared for women with uterine fibroids had known for some time. They evaluated close to 1,000 women who suffered from fibroids and they found that the average time from diagnosis to treatment was three and a half years with nearly one-quarter of them waiting five years or more. When the researchers asked why they had waited, most of the women said they did not want surgery, and they weren’t given a non-surgical option like Uterine Fibroid Embolization (UFE).

Women are demanding less invasive treatments for fibroids. UFE has been available for the past 25 years and remains the best nonsurgical treatment option for fibroids. However, Gynecologists do not perform UFE, and a number of less invasive options have been released that Gynecologists can offer instead of the traditional surgical options: hysterectomy or myomectomy. Four years ago, a new surgical procedure Acessa, started appearing in clinical trials.

Uterine Fibroid Embolization in Atlanta, GA

What Is Acessa™ and How Does It Work?

Acessa™ is a registered trademark of the medical technology system used to perform laparoscopic radio-frequency ablation. Radio-frequency ablation or RFA utilizes radio-frequency technology to treat different medical conditions including uterine fibroids. Laparoscopic means that the procedure involves a laparoscope (a tiny camera) inserted into the body through relatively small incisions. Acessa™ received FDA approval in 2012.

Unlike UFE, the Acessa procedure is a surgical procedure and performed under general anesthesia. Usually, this is performed in a hospital or an ambulatory surgical center (ASC). The Acessa system consists of three devices: a laparoscope and an ultrasound probe for diagnostics and real-time guidance, and the Acessa handpiece to perform radio-frequency ablation and destroy fibroids. The surgeon treats fibroids one by one by heating the fibroid tissue with radio-frequency energy until it dies. Then, fibroids shrink and soften. The dead fibroid tissue is not harmful and can get absorbed by the body later.

To learn about the UFE procedure in detail, read our FAQs.

What Is the Difference Between Uterine Fibroid Embolization (UFE) and Acessa™?

Both UFE and Acessa™ are used to treat uterine fibroids. Although both methods are positioned as an alternative to hysterectomy and myomectomy, there are significant differences to be considered when identifying the best fibroid treatment solution for you.

Our comparison intends to provide answers to women with symptomatic fibroids who are considering Acessa vs UFE. We encourage you to do your research to understand the choices you have and to pick the best option for you.

UFE vs. Acessa™: General Questions

Acessa™ UFE
What type of medical procedure is it? A minimally invasive surgery A minimally invasive non-surgical procedure
How does the procedure work? By heating the fibroid’s tissue until it dies By blocking blood flow to fibroids that leads to their death
Does the uterus get manipulated? No, the uterus is fully preserved No, the uterus is fully preserved
Who performs the procedure? An OB/GYN An Interventional Radiologist (like Dr. John Lipman)
Where is the procedure performed? In an outpatient center or a hospital In an outpatient center (like Atlanta Fibroid Center) or a hospital
What type of anesthesia is used? General anesthesia. Local anesthesia or intravenous sedation
How long does the procedure take? 2 hours In Atlanta Fibroid Center it takes 30-45 minutes
Is the procedure painful? No pain during the procedure, but cramping or pelvic pain after No pain during the procedure, but possibly cramping or pelvic pain after
How long does recovery take? Up to a week Up to a week (usually, 4-5 days)
Is the procedure covered by insurance companies? Covered by only a few insurance companies Covered by ALL insurance companies, including Medicare and Medicaid

Both UFE and Acessa™ allow women to keep their uterus, which is undoubtedly an advantage over traditional, open fibroid surgeries. However, there are numerous advantages of UFE over Acessa™.

First, UFE is nonsurgical and therefore safer than the surgical procedure Acessa™. Second, UFE treats all of the fibroids whereas Acessa cannot and will address only the dominant ones. Third, UFE is covered by all insurances including Medicare & Medicaid. Acessa™ is only covered by a few insurance companies as it has only been in clinical trials for less than 5 years (UFE has been available for the past 25 years). In addition, the recovery process after UFE is usually slightly shorter since no general anesthesia is involved.

Who Is a Good Candidate for the Procedure?

Acessa™ UFE
What is the age limit for the procedure? No limit, but usually it’s women between 35-55 y.o. No limit, but usually it’s women between 35-55 y.o.
What type of fibroids can be treated with the procedure? Fibroids NOT located in the cavity, must be <10cm All sizes, types, and locations of fibroids
How many fibroids can be treated during one procedure? Those that are NOT located in the uterus cavity All
Can the procedure treat large fibroids? No Yes, all fibroids regardless of their size and number
Are future pregnancies possible after the procedure? Insufficient data Yes!
Can the procedure treat Adenomyosis? No Yes

Generally speaking, women that undergo UFE and Acessa™ procedures are similar in age, but due to a lack of sufficient data, some categories of patients are not recommended to undergo Acessa™. These are the women with enlarged uterus due to fibroids (larger than “14-week pregnancy”) and women planning future pregnancies. Besides, women with fibroids located within the uterus cavity are also ineligible candidates; the procedure is technically limited to treating only fibroids outside of the uterus cavity. Also, Acessa™ cannot treat adenomyosis.

What Should I Expect From the Procedure?

Acessa™ UFE
Does the procedure involve incisions? Yes, at least 2 surgical incisions (3/16 inch and 3/8 inch long) Yes, one non-surgical incision (1/32 inch long, so small that patients only need a bandaid after the procedure)
Does the procedure involve stitching? Yes No
What is the success rate of this procedure? No long term data yet. Early results satisfactory 90% based on 25 years of clinical data and peer-reviewed studies
When can patients return home? The same day after the procedure. The same day after the procedure
What is the chance that fibroids re-grow or new ones occur, and the second procedure is required? 5% 5%
How much do fibroids shrink after the procedure? 50% decrease by 12 months 40-50% by 3 months, 60-70% 6 months-1 year
When will patients feel symptom relief? In 3-6 months Some relief in symptoms nearly immediately with further relief in the next 3-6 months after the procedure
Does the procedure provoke menopause? No data Very rarely and only seen in women over 40 years of age

There are some risks associated with Acessa™ and UFE. However, the chance of a complication after UFE is <1%.

In the case of Acessa™, the following risks can occur: skin burns, mild intra-operative bleeding, transient urinary retention or urinary tract infection, adhesion formation, post-procedural discomfort (cramping, pelvic pain), and transient amenorrhea, infection, injury to adjacent structures, vaginal bleeding and temporary anemia, blood loss requiring transfusion or hysterectomy, pneumothorax, wound dehiscence, deep vein thrombosis, treatment failure, and complications related to laparoscopy and/or general anesthesia.

Can You Get The Acessa Procedure For Large Fibroids?

The Acessa procedure can be used to treat fibroids that are less than 10 cm in diameter (under 4”), but it is not recommended for fibroids beyond this size. It also has limitations regarding fibroid location, as it is not suitable for the treatment of fibroids growing in the uterine cavity or pedunculated fibroids. It is also not recommended for women with numerous fibroids or those who have fibroids that are closely connected.

Because UFE does not rely on the ability to access the fibroid itself with a medical instrument, there are no location limitations as there are with the Acessa procedure. Also, UFE does not have limits on the size of the fibroid it can safely treat, so UFE is a good option for women with large fibroids who do not want surgery.

Does The Acessa Procedure For Fibroids Preserve Fertility?

For those contemplating the Acessa procedure for fibroids, it is important to keep in mind that their company website advises against the procedure for anyone planning to have children in the future. It further cautions patients who have had the Acessa procedure to contact their doctor immediately if they do become pregnant.

UFE keeps the uterus intact with no damage or compromised areas, so there is no risk of uterine rupture during a future pregnancy or delivery.

If after careful consideration you decide to opt for UFE, make sure you are in the best hands possible, in the hands of a very experienced and knowledgeable Interventional Radiologist. Dr. John Lipman is one of the world’s most experienced UFE physicians with over 8,000 procedures performed. Please visit ATLii.com for more information or make an appointment with Dr. John Lipman by calling Atlanta Fibroid Center at 770-953-2600.


References:
1 – Elizabeth A. Stewart, Wanda K. Nicholson, Linda Bradley, and Bijan J. Borah. The Burden of Uterine Fibroids for African-American Women. Journal of Women’s Health. Oct 2013.807-816.

Read more

Icon
close