The 21st APAGE Congress (APAGE 2021) – High Intensity Focused Ultrasound (HIFU) Special Seminar brought to a successful close on September 12th, on which we invited 5 excellent speakers experienced in the field of minimally-invasive and non-invasive gynecological surgery to present clinical application and pregnancy outcome of HIFU, with two distinguished chairs Prof. Tsutsumi Osamu from Japan and Dr. Lee Keen Whye from Singapore. Let’s take a look back and enter a new era together!

Prof. David Cranston, the President of International Society of Minimally Invasive and Virtual Surgery (ISMIVS) and the Associate Professor of Surgery in the Nuffield Department of Surgical Science, shared the development of HIFU in Oxfrod for last 20 years. He first introduced clinical treatments and trials of HIFU on fibroids, liver, kidney, renal transplant and sacral chordomas. Then he gave a detailed introduction on renal and liver tumour trial in Oxford, including related papers and how HIFU works in diagnosis and surgery. Prof. David Cranston also compared the pre- and post-HIFU MRIs of a patient received renal transplant and concluded his speech with a quotes of Theodore Roosevelt to encourage clinicians who are engaged in the innovative research of HIFU to keep breaking the boundaries of knowledge.

Prof. Felix Wong, the Conjoint Professor of the University of New South Wales and Chairman of CA-AMIGO, shared his career path in the field of gynecological surgery and the technology development for the treatment of uterine fibroids from open surgery to laparoscopy, then to HIFU. Felix pointed out both advantages and disadvantages of hysterectomy and laparoscopic myomectomy for uterine fibroids, and introduced another alternative path of single port robotic surgery. After that, he shared his journey with HIFU, a unique and non-invasive FUS surgery which is able to improve the safety and efficacy of treatment and further reduce complications. Prof. Felix Wong concluded that he was looking forward to see more progress in this new technology, for which he believed would benefit women health.

Prof. Aixingzi Aili from Shanghai First Maternity and Infant Hospital delivered a speech themed on “HIFU Treatment for Adenomyosis and the Pregnancy Outcome”. Based on her 20-year experience in endometriosis and adenomyosis treatment and research, Prof. Aili elaborated the principles of HIFU ablation and shared a three-step therapy of HIFU combined with GnRHa and LNG-IUS for patients with adenomyosis. She indicated that HIFU treatment did not affect ovarian reserve of women through a comparison figure of uterine volume and lesion volume before and post HIFU ablation in 54 cases, and concluded that HIFU ablation may improve uterine movement and uterine cavity morphology by ablating lesions, thus contributing to fertility.

Dr. Jordi Rodriguez from Mutua Terrassa University Hospital, Spain, shared his clinical experience centered on “HIFU Treatment for Uterine Fibroids and the Pregnancy Outcome”. Dr. Jordi Rodriguez first explained the effect of uterine fibroids on fertility and treatment options, then indicated two goals of HIFU treatment for fertile women with uterine fibroids, including the inactivation of fibroid tissues and shrinkage of fibroids with gradual restoration of uterus structure. He demonstrated some academic papers in terms of HIFU and fertility and a table of obstetric characteristics of 43 successful deliveries achieved after ultrasound guided HIFU (USgHIFU) treatment, and concluded that patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postparturm complications.

Dr. Selva (Sevellaraja Supermaniam), former President of APAGE, a Consultant Obstetrician and Gynecologist at Mahkota Medical Center, Melaka, Malaysia, showed a surgery video of using HIFU to treat uterine fibroids and introduced lesion positioning, operation skills and therapeutic effects of the HIFU surgery. He believed HIFU can be performed to ablate and shrink fibroids in an effective and non-invasive way.