• Dr Peter Chew

Surgery without knife ---Hifu, a new approach

Updated: Oct 22, 2019

Recently, I attended a medical workshop and seminar on HIFU in China. It is an innovative way of removing a solid growth in the abdomen without open surgery.


Hifu stands for high-intensity focused ultrasound, a therapeutic system in which ultrasound beams are focused to generate localized heat to destroy tumour cells without damaging the surrounding organs. It is done with no skin puncture or incision. The way heat is generated by the ultrasound beams is similar to that using a magnifying glass to focus light from the sun.

In female diseases, Hifu can be used to treat


· Uterine fibroids -- a noncancerous growth in the muscle walls of the womb

· Adenomyosis/adenomyoma--a painful condition where the lining of the womb is embedded in its muscle walls

· Placenta accreta, an uncommon condition in which the after-birth is very adherent to the womb

· Caesarean scar pregnancy, a form of ectopic pregnancy

· Non-cancerous breast lumps


The advantages of Hifu surgery is that it is non-invasive with low complication rates comparable to or less than those of key-hole surgery. Patient can go back to normal activities quickly after the procedure.


However, the procedure may not be suitable if the patient has:

· Severe heart or respiratory diseases

· Previous multiple abdominal surgery or radiotherapy

· Acute infection

· Suspected cancerous change in the fibroid

· Difficulty lying prone for at least an hour

Common reactions to Hifu surgery include

· Bloated feeling in the lower abdomen,

· Pain at the buttock and legs which is usually short-lived

· Temporary weakness in the legs.

· Redness of skin and feeling of heat in the treatment area


Rare complications include injuries to the bowels and bladder which is less than 0.1 %.

For the treatment of uterine fibroids, the patient is carefully positioned in a prone position on a movable table that slides her lower abdomen into the opening of the ultrasound scanner (fig 1&2). Sedation is given during the procedure to prevent unnecessary body movement of the patient.


Focused ultrasound waves(sonication) are used to heat up the fibroid in small portions up to 100 deg C. Tissue changes in the fibroid are monitored. The process is repeated until most of fibroid is burned.


Each sonication lasts a few second and there is a rest period to let the tissue cool down. Depending on the size and number of fibroids, it usually takes one to two hours to complete the procedure.


Throughout the procedure, patient will be asked about the level of pain, the feeling of heat on her abdominal skin, legs and buttock and the ability to move the legs.


After treatment, there may be slight vaginal bleeding and some watery vaginal discharge but they are usually transient and disappear after a few days. Depending on the size of the fibroid, it may take a few months for the fibroid to be absorbed by the body. But most women would notice significant improvement in their fibroid-related symptoms shortly after the treatment.

Hifu offers an alternative option for women who would like to have children as integrity of the womb is maintained and normal vaginal delivery can be achieved with reduced risks of uterine rupture. A number of women with fertility issues have been successfully treated with Hifu. However, further studies are needed to explore the long‐term outcomes.






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