The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on magnetic resonance (MR) image-guided percutaneous laser ablation of uterine fibroids.
As part of NICE's work programme, the current guidance was considered for review in May 2009 but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
This procedure is used to treat uterine fibroids (also known as uterine leiomyomas or uterine myomas).
Symptoms caused by fibroids include abnormal bleeding, pelvic pressure and pain, and reproductive problems. Fibroids are common and are the most frequent reason for a woman to have a hysterectomy.
Magnetic resonance (MR) image guided percutaneous laser ablation is a minimally invasive technique for the treatment of uterine fibroids. Patients are given intravenous sedation and analgesia and a catheter is placed in the bladder.
Under MR guidance needles are inserted into the centre of the targeted uterine fibroid through an area of skin that has been anaesthetised. Bare laser fibres are inserted down the centre of each of the needles into the targeted fibroid. Laser energy is then used to destroy the fibroid.
A thermal mapping sequence is then used to depict the extent of the heated tissue in the target area as the procedure is carried out. Each procedure may involve up to three successive power applications in an overlapping manner to cover as much of the target fibroid as possible whilst monitoring the exact site of heat deposition with thermal mapping.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.