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Episode 4 closing at December 16th marked a wrap for APAGE-ISMIVS 2021 HIFU Series Webinars. Thanks to all of our speakers and audience for attending over the last few months. We hope the 4 webinars would expand your insights in the field of gynaecological surgery and somehow contribute to minimally invasive and noninvasive medicine.

Dr. Lee Keen Whye, the Leading Consultant Obstetrician and Gynaecologist at the Gleneagles Medical Centre, Singapore, opened the seminar by emphasizing the importance of treating benign tumors such as fibroid and adenomyosis and introducing the development of gynaecological surgery from laparotomy to HIFU. Then, he brought a lecture themed on The Learning Curve of HIFU, during which he first compared the main differences between MRI-guided HIFU and Ultrasound-guided HIFU which was indicated to be more flexible and efficient with shorter treatment time. Over the last 3 years, he had managed 118 patients with HIFU therapy, among which 83 cases with fibroids, 26 with adenomyosis and 9 mix symptoms with 123 min of average treatment time. Based on such rich clinical experience, he shared a three-stage method to learn HIFU. He also elaborated 4 cases of uterine fibroid and 2 cases of adenomyosis and concluded that HIFU was revolutionary and disruptive to the world of gynaecological surgery which he believed more women would choose in the future.

Prof. Fong Yoke Fai from the Department of Obstetrics and Gynaecology, National University of Singapore, shared his clinical experience using HIFU to treat uterine fibroids and adenomyosis. He introduced the principal of HIFU and indicated that HIFU was an advanced non-invasive and non-surgical technology with little downtime and allowing patient to resume daily activities after treatment. Till December 2021, Farrer Park Hospital Day Surgery Centre had done 173 cases of HIFU in total, for follow-ups of these cases after HIFU treatment, there were no skin burns, 1 case of L4 nerve root radiculopathy (complete recovery after 3 months), 6 cases of pregnancies (3 fibroids, 3 adenomyosis).

Dr. P.M. Gopinath, the Director of Obstetrics and Gynecology, SIMS Hospital, India, mainly introduced the pre-treatment of fibroids and adenomyosis in ART. He first explained the mechanism of impaired fertility in case of intramural-submucosal myoma and discussed the impact of myoma on fertility. He also presented the pregnancy rate and miscarriage rate of intramural leiomyoma after IVF and then provided 5 treatment options for fibroids including medical therapy, open surgery, laparoscopy, robotic surgery and HIFU. After comparing the old and new techniques of reduction surgery for adenomyosis, he concluded that HIFU was well tolerated by patients, and the mean uterine volume decreased by 12.7%, the symptom severity score improved significantly and no serious complications were observed.

Dr. He Min from Chongqing Haifu Hospital further shared treatment strategies for difficult cases of HIFU. She indicated that to achieve safety, effectiveness and efficiency of HIFU treatment, 6 factors including BMI, the position of the uterus, number and position of the fibroids, blood supply and T2WI should be considered. Then she shared difficult cases of the posterior uterus, multiple fibroids and adenomyosis with hysteromyoma/chocolate cyst, as well as potential responding strategies. As the director of the Training Department, Engineering Research Center of Ultrasound Medicine, China, Dr He Min was also involved in the Q&A part to address the problems and concerns participants had in terms of device operation and treatment planning.