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 to diagnosis to treatment was three and a half years with nearly one-quarter of them waited 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.
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 hand-piece 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.
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
|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?
|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?
|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.
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.
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.