Best Fibroid Doctor In Philadelphia – When Kelly Heidelberg’s case of anemia led to heavy bleeding from uterine fibroids, she faced a tough choice that thousands of American women face every year.
Dr. Minda Green (left) and others. Deepak Dalwoodia (right) of Drexel Medicine talks with patient Kelly Heidelberg of Philadelphia about an ultrasound procedure for fibroids Monday, April 25 at Hahnemann Hospital in Philadelphia. , 2016. This operation is the second in Philadelphia. Read more for TRACIE VAN AUKEN/
Best Fibroid Doctor In Philadelphia
She can surgically remove the uterus or fibroids, or she can try one of several new procedures aimed at shrinking the usually benign but troublesome growths. At 46, she might try waiting a few years to see if menopause, the natural decline of hormones, will fix the problem.
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However, Heidelberg’s options are more limited because she doesn’t want to undergo surgery with a long recovery that would take her away from work and family. Even with iron supplements, her anemia was so severe that waiting for fibroids was not a good idea.
But her gynecologist, Minda Green, suggested another option: a new tool that doesn’t require an incision and uses heat to damage the fibroids, causing them to shrink. Although the tool is still being tested, what Heidelberg has heard is great.
“With this option, I have a better chance of a faster recovery and return to work,” said Heidelberg, who lives in Olney. Last month, the mother of two underwent an outpatient procedure at Hanaman Hospital without incident and returned home the same day. A few days later, she returned to work as a corrections officer in Philadelphia.
Sonata, short for transcervical sonography-guided ablation, a device made by California-based Gynasonics promises to add to the ways of treating the common condition, but it faces easy solutions.
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“It’s probably the least invasive surgical procedure you can do,” said Green, an assistant professor at Drexel University College of Medicine who was a co-investigator on the Hahnemann device trial with Drexel. “It’s important … you can get back to work and life. That’s what women want.”
Sonata uses a tube inserted through the uterus into the uterus. This test not only allows the doctor to look at the fibroid with an ultrasound but also includes a radio frequency device at the end. The doctor presses a foot pedal to send energy through the probe to heat the muscle, causing it to contract over time. The body absorbs the dead tissue, so it does not need to be surgically removed.
The tool has also been tested at 26 other sites in the United States, including Cooper University Hospital and Christiana Care Health System.
Fibroids are muscular growths, usually benign, that grow in the wall of the uterus. They can affect up to 80 percent of women by age 50, but in most cases, fibroids don’t cause symptoms. Sometimes symptoms are mild, and women can treat them with hormone therapy or wait until menopause.
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But for some women, significant fibroids can mean heavy bleeding, cramping, and pain from the pressure they cause. They can also cause problems during childbirth and in rare cases affect fertility. According to the National Uterine Fibroid Foundation, about a quarter of women with fibroids need treatment.
Heidelberg had lost so much blood during her severe periods that she was very anemic. Of her five fibroids, four were deep in the uterine wall.
Millions of hysterectomies are performed each year in the US, mostly to treat uterine fibroids, making this procedure the most common option.
But it’s major surgery, which can mean a long recovery time, increasing the demand for alternatives, from hormone therapy to more complex procedures. Although hysterectomies are not performed as often as they once were, their rate is often considered very high.
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Another option is to remove only the fibroid, a procedure called a myomectomy. But it is an invasive procedure that requires an incision and a long recovery time. And unlike a hysterectomy, there’s no guarantee that fibroids won’t grow back after a hysterectomy.
Power morcellation, a technique that cuts the uterus (or simply fibroids) for removal through small incisions, has been seen as a solution by some, promising a faster recovery time than traditional open hysterectomy. But in some cases—the FDA estimates one in 350—the device spreads undiagnosed cancers that operative screening tests cannot reliably detect. The FDA advises doctors and hospitals not to use it except in rare cases.
Sonata is not the first procedure aimed at shrinking fibroids without surgery, although it is considered less invasive.
In uterine artery embolization (UAE), an interventional radiologist uses a catheter in the groin to deliver tiny cells that block blood flow to the fibroids. But some women, including Heidelberg, put it off because it can be painful as the fibroids shrink.
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Other options include Acessa, a treatment that uses laparoscopic radiofrequency waves to destroy tissue. Also tested at Hahnemann, it was approved in 2012 and heats the muscle, but requires two smaller incisions and uses more instruments than the all-in-one Sonata test.
ExAblate is an MRI-guided technology that uses focused magnetic energy to ablate tissue. This can take hours and shrink fibroids by less than 20 percent, studies show.
“The market is by no means crowded,” says Erin Carey, assistant professor and director of the minimally invasive gynecology department at the University of North Carolina-Chapel Hill, who was not involved in the Sonata trial. “There’s huge room for growth.”
Deepak Dalwadia, assistant professor of OB/GYN at Drexel, the trial’s principal investigator, said it works on fibroids in the wall of the uterus between 1 and 5 centimeters in size.
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“We’ve been trying to get at these types of fibroids and tumors in a minimally invasive way for a long time,” he said.
During the procedure, Heidelberg is under general anesthesia, but the Sonata can be used in an office setting with partial sedation, according to GynaSonics. Green, under whose supervision Delvadia first performed the procedure, passed the probe through the cervix and into the uterus, where she was able to see a vivid two-dimensional image of the fibroids.
Green then placed the electrodes, which reach 221 degrees Fahrenheit, taking care to remove or heat as much of the muscle as possible without damaging the surrounding tissue.
Depending on the location and characteristics of the fibroid, the system calibrates how long the ablation will take. Heidelberg’s first bodybuilder needed 4 minutes and 36 seconds. Then turns green to take the next one.
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Compared to the Asesa procedure, which requires the doctor to manipulate multiple instruments, the Sonata is “much easier,” Green later said. She also pointed out that the procedure does not require a radiologist.
The Sonata was adopted in Europe a few years ago and has received positive reviews here so far. But because it’s still under investigation in the US, it’s not covered by insurance (patients like Heidelberg in the trial are treated for free).
“If insurance doesn’t pay for Sonata, no one is going to get it,” says Jay Goldberg, a professor and director of the Physical Therapy Center at Einstein Medical Center in Philadelphia. ExAblate, which is not usually covered by insurance, costs “tens of thousands of dollars out of pocket” — one reason it’s not often used, he noted.
The Sonata maker declined to say how much the process will cost once trials are completed and approved.
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One of the advantages of the Sonata is that it is relatively easy to administer, making it accessible to more physicians. But Goldberg notes that such minimally invasive procedures require great skill to perform safely. “You want a really experienced surgeon,” he says. “Does this translate to the average physician?”
Fibroids are rarely malignant, but UNC’s Carey noted that because the Sonnett method does not remove the tissue, a biopsy cannot be performed to make a definitive diagnosis.
Carey also wants to learn more about Sonata’s potential effect on fertility. The trial is aimed at women who are not interested in becoming pregnant in the future, so that issue will not be raised in the trial, but the procedure will not harm fertility, said David Towe, Gynasonics’ medical director.
If further research proves it doesn’t affect fertility, Carey said, that would make Sonata “a game changer. That would improve the product.”
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Meanwhile, Heidelberg is happy with her choice, which she says was painless and allowed her to get back to normal quickly. Uterine fibroids are common and are estimated to appear in 70% of women by the time they reach menopause. Some are very large and can cause heavy menstrual bleeding or pelvic pressure.
Uterine fibroids, also known as leiomyomas, are benign solid tumors that develop in a woman’s uterus. They are common and are estimated to occur in 70% of women around the time of menopause. Some tumors can