What is Acessa?

Acessa: Radiofrequency Ablation for Uterine Fibroids

Acessa is a minimally invasive laparoscopic procedure that uses radiofrequency volumetric thermal ablation to treat symptomatic uterine fibroids while preserving the uterus. This technology represents an important uterine-sparing treatment option for women with symptomatic fibroids who wish to avoid hysterectomy.

Procedure Details

Acessa involves:

1. Laparoscopic approach with ultrasound guidance
2. Identification of fibroids using intraoperative ultrasound
3. Targeted radiofrequency energy delivery to each fibroid
4. Thermal ablation that causes coagulative necrosis of the fibroid tissue
5. Outpatient procedure with typical operative time of 1.9-2.1 hours 1

Clinical Applications and Benefits

• Preserves the uterus - Critical for women desiring future fertility
• Treats multiple fibroids - Can address various sizes and locations
• Minimally invasive - Requires only small abdominal incisions
• Outpatient procedure - Typically no hospital stay required
• Rapid recovery - Faster return to normal activities compared to traditional surgery
• Low complication rate - Studies show minimal intraoperative and postoperative complications 1

Patient Selection

Acessa is most appropriate for:

• Premenopausal women with symptomatic fibroids
• Patients desiring uterine preservation
• Women with fibroids causing abnormal uterine bleeding, pelvic pressure, or pain
• Patients who have failed medical management
• Those seeking alternatives to hysterectomy or myomectomy

Clinical Outcomes

Clinical studies demonstrate:

• Effective symptom relief for abnormal uterine bleeding and bulk symptoms
• Reduction in fibroid volume
• High patient satisfaction rates
• Low reintervention rates
• Minimal recovery time with most patients returning to normal activities within 1 week 1

Learning Curve for Surgeons

Surgeons new to the Acessa procedure can typically gain proficiency after 2-5 proctored cases. A study of ten gynecologic surgeons without prior Acessa experience showed they could safely perform the procedure with acceptable outcomes after this brief training period 1.

Position in Treatment Algorithm

Acessa should be considered in the following clinical scenarios:

1. After failed medical therapy - For patients who have not responded to hormonal contraceptives, tranexamic acid, or NSAIDs for heavy menstrual bleeding 2
2. As an alternative to myomectomy - Particularly when multiple fibroids are present
3. Instead of hysterectomy - When uterine preservation is desired
4. As an option alongside other uterine-sparing procedures - Such as uterine artery embolization (UAE) or MR-guided focused ultrasound (MRgFUS) 3

Comparison to Other Fibroid Treatments

Acessa offers several advantages compared to other treatment options:

• Versus hysterectomy: Preserves the uterus, shorter recovery time
• Versus myomectomy: Less blood loss, ability to treat multiple fibroids without multiple incisions
• Versus UAE: More precise targeting of fibroids, potentially fewer post-procedure pain symptoms
• Versus MRgFUS: Can treat a wider range of fibroid types and locations

Potential Complications

Though rare, potential complications include:

• Uterine serosal laceration
• Bleeding from probe insertion sites
• Thermal injury to surrounding structures
• Infection
• Recurrence of fibroid symptoms 1

The Acessa procedure represents an important addition to the armamentarium for treating symptomatic uterine fibroids, offering a minimally invasive, uterine-sparing option that can effectively reduce symptoms and improve quality of life for women with this common condition.