This document discusses the experience of Dr. Abayomi Ajayi treating the first 100 patients with uterine fibroids and adenomyosis using ultrasound-guided High-Intensity Focused Ultrasound (HIFU). Key points include: HIFU provided an 85-90% ablation rate immediately post-operation with few minor complications; fibroid volume shrank 36% on average 3 months post-HIFU and 51% at 6 months; HIFU allows for a much faster recovery compared to other fibroid treatment options like hysterectomy or myomectomy. The conclusion is that HIFU is a safe option for preserving fertility in women with fibroids or adenomyosis.

1. Dr Abayomi Ajayi. 9th May 2022
Experience With The 1st 100 Patients
With Uterine Fibroids and Adenomyosis
treated with Ultra Sound Guided HIFU
by
Dr. Abayomi Ajayi

2. Dr Abayomi Ajayi. 9th May 2022
Dr Abayomi Ajayi. 9th May 2022
Greetings From Lagos, Nigeria

3. Dr Abayomi Ajayi. 9th May 2022
•Uterine fibroids (leiomyomas or myomas) are the most common
benign pelvic tumours in pre-menopausal women, with an
approximate 70 to 80 percent lifetime risk. They represent clonal
expansion of individual myometrial cells.
•There are many management options for fibroid-related symptoms,
including:
• expectant management
• medical therapy
• non-excisional procedures (uterine artery embolization, High-intensity focused
ultrasound),
• surgery (myomectomy, hysterectomy).

4. Dr Abayomi Ajayi. 9th May 2022
Factors Considered in Choosing Appropriate
Option
Treatmentof fibroidsisusuallydependentonwhether
a) Youhavesymptoms
b) Wanttogetpregnant
d) Age
e) LocationofFibroid

5. Dr Abayomi Ajayi. 9th May 2022
Present
Future

6. Dr Abayomi Ajayi. 9th May 2022
HIFU

7. Dr Abayomi Ajayi. 9th May 2022
Advantages
●Day procedure
●Non invasive
- uterine sparring
- precise ablation to target area - doesn’t not affect normal uterine tissue - allows for normal
vaginal delivery in future pregnancies
●No general anaesthetic
●Faster recovery period
- return to work within days
●Non ionizing radiation
- procedure can be repeated
- no damage to ovaries

8. Dr Abayomi Ajayi. 9th May 2022
● Cost-effective
- decreased hospital stay
- no blood transfusion required
● No HIV transmission
● Safe, low risk of complication

9. Dr Abayomi Ajayi. 9th May 2022
Is HIFU For Everyone?
• Significantly over weight : > 120kg
• Mid line vertical incision
• Fibroid Type 0 and 7
• Patients with a history of abdominal
liposuction
• Patients that are not suitable for
analgesia and sedation
• Patients with communication
difficulties
Relative Contraindications

10. Dr Abayomi Ajayi. 9th May 2022
Absolute Contraindications
• Patients with history of radiotherapy
on the lower abdomen.
• Patients with non-benign cervical,
ovarian, and other gynecological
diseases, including uterine sarcoma,
cervical and ovarian cancer, etc.
• Patients who cannot lie in prone
position for at least 1 hour because of
lumbar disc diseases or other causes.
• Patients with fibroids suspected of
malignancy

11. Dr Abayomi Ajayi. 9th May 2022
Present
• Myomectomy is the commoner surgery for fibroid treatment in
Nigeria representing between 75.6%) and 90.3% in different
parts of the country.

12. Dr Abayomi Ajayi. 9th May 2022
Complications from Surgery
• Early
1.Haemorrhage
2.Blood transfusion
3.Anaesthetic complications
4.Hysterectomy
• Late
1. Embolic phenomena
2. Intrauterine Adhesions
3. Recurrence

13. Dr Abayomi Ajayi. 9th May 2022
Present Future

14. Dr Abayomi Ajayi. 9th May 2022
“If the tool you have is a hammer,
You tend to see every problem as a nail”
Abraham Maslow’s Law of the instrument

15. Dr Abayomi Ajayi. 9th May 2022
Comparison of recovery time
Procedure Estimated recovery time
US guided HIFU 1-2 days
Hysterectomy 4-6 weeks
Myomectomy 4-6 weeks
Laparoscopy Myomectomy or
Laparoscopy Hysterectomy
2-3 weeks
Uterine Artery Embolization 1-2 weeks

16. Dr Abayomi Ajayi. 9th May 2022
HIFU IN NIGERIA: EXPERIENCE WITH OUR FIRST 100 PATIENTS
•100 patients
•80 — UF only
•14 — UF + Adenomyosis
•6 — Adenomyosis only
•Associated with infertility: 56
•Age range: 24 — 50 years
•Average ablation rate (immediately post-op)
85-90%
•Test of ovarian reserve < 37 years
No significant changes in AMH
20 women with Adenomyosis
5 had open myomectomy in the past

17. Dr Abayomi Ajayi. 9th May 2022
Shrinkage rate (myoma volume)
Post HIFU Hysteroscopy : 14
Diagnostic — 4
Submucous fibroids — 10
3 months 6 months
36 ± 15% 51 ± 17%
No of women 55 27

18. Dr Abayomi Ajayi. 9th May 2022
Complications
Intra-operative complaints
●21 lower abdominal cramps
●3 Transient leg pain
●7 lower back pain
●12 skin burning sensation
Delayed post HIFU complaints
●8 — heavy menstrual bleeding
4 — had type 2-4 fibroid
4 had Adenomyosis
●7 — watery vaginal discharge
●1 — pelvic pain

19. Dr Abayomi Ajayi. 9th May 2022

20. Dr Abayomi Ajayi. 9th May 2022
Conclusion
HIFU is a safe option in the management of women with uterine fibroids and Adenomyosis
especially when such women are desirous of preserving their fertility .
The prevalence of uterine fibroids in women of reproductive age group and the emerging
evidence of a shorter treatment to pregnancy interval compared to all other options calls for a
larger clinical trial.

21. Dr Abayomi Ajayi. 9th May 2022