Ablatherm® HIFU Treatment Step by Step
How is the Ablatherm® HIFU treatment performed?
There are 2 phases in Ablatherm® HIFU treatment :
- The definition of the area to be treated : intraoperative treatment
- Ablatherm® HIFU robot performs the treatment that has previously been defined by the surgeon : an automated treatment
The prostate cancer patient is hospitalized the evening before the treatment. The patient is given an enema for colorectal preparation approximately two hours before treatment.
|Ablatherm® HIFU is made up of 2 modules: the treatment module on which the patient is positioned and the control module which enables the surgeon to plan and check the treatment via a computerized system which guides the robotic endorectal probe.|
|The probe is mounted on a mobile support. The ultrasound generator and the integrated ultrasound scanning equipment (or transducers) are located on the end of the probe.|
|The probe's mobile support is an instrument with robotic movements which enables the device to move the probe automatically and precisely during the treatment to treat the whole prostate.|
||After a local or general anaesthetic is administered, the patient lies down on his right hand side (right lateral decubitus) and stays in this position throughout the treatment.|
|The probe is covered with a balloon filled with a degassed liquid, then it is lubricated and inserted into the rectum via the anus. This non-invasive position enables the probe to be positioned near the prostate, which is then accessible for ultrasound treatment.|
Intraoperative treatment planning
|The first phase of the treatment involves an ultrasound scan of the prostate. Thanks to the 7.5 MHz of the imaging transducer, Ablatherm® HIFU device is able to produce a very high definition image. Treatment planning starts by the localization of the prostate apex and of the rectum wall to define the appropriate lesion height and safety distance from the rectal wall.|
|The computerized system will then recreate a three-dimensional picture of the prostate to enable the surgeon to plan the treatment on the screen, and to program the robot to define the area to be treated. The prostate is then divided into a series of blocks. For each defined area, the software (Ablaview) will calculate the appropriate number of lesions.|
|The 3.0 MHz probe creates an ablation volume which is adjustable from 19 mm x 1.7mm x 1.7 mm (total volume = 29 mm3) to 26 mm (anterior to posterior) x 1.7 mm x 1.7 mm (total volume = 36 mm3).|
|Once the treatment has been planned the shooting phase can begin.
The lesion height range from 19 to 26mm (anterior-posterior distance) enables the prostate to be treated in a single pass. To cover the whole prostate volume, between 400 and 800 adjacent elementary lesions are required.
|The robotic probe then carries out the surgeon's instructions automatically and extremely precisely (orders are accurate to within a few millimeters).|
|Every 10 seconds the probe generates a high intensity focused ultrasound beam which is used to destroy a very small part of the prostate with intense, very fast, highly localized heat. The targeted zone destroyed by each shot is oval-shaped and measures up to 26 mm in height by less than 2 mm in diameter.|
|This phenomenon generates almost no pain for the patient after treatment. The initial lesion will be followed by a number of adjacent lesions, several hundred in fact, which gradually, one after the other, enable the entire prostate to be treated.|
|The treatment then continues, lasting between one and a half and two and a half hours depending on the volume of the prostate.|
Quick recovery after treatment
HIFU treatment is followed by an immediate increase of the prostate volume due to edema and inflammation. Swelling of the prostate appears immediately after the treatment and compresses the urethra. A temporary urinary catheter is inserted. This allows the elimination of urine until the edema recedes (which takes generally from 3 to 8 days). To reduce the need for post treatment catheterization, a transurethral resection (TURP) is generally done before the treatment with Ablatherm® HIFU (during the same anesthesia): this is mainly performed on patients whose prostate presents with signs of hyperplasia (prostate greater than 35cc) and prostatic obstruction (weak urinary stream, frequent nocturnal urination, and residual urine volume in the bladder). Moreover, this TURP eliminating part of the central hyperplasic prostatic tissue, has been demonstrated to decrease the duration of the treatment significantly.
The patient is able to return to normal food the evening of the treatment day, and the urinary catheter is generally removed 3 or 4 days after the session. The patient is usually discharged from hospital the day following the treatment.
A prophylactic medication may be prescribed for the following weeks to prevent the occurrence of a urinary infection. PSA level measurements and the urinalyses are performed regularly.
Ablatherm® HIFU animation
Hifu Planet a patient web site
HIFU PLANET website was set up to provide patients with useful information relating to prostate cancer treatments and particularly on Ablatherm® HIFU treatment. The web site is now available in several languages.