Noninvasive High-intensity Focused Ultrasound Surgeries for Fibroids and Adenomyosis during COVID-19 Pandemic in Hong Kong: A Gynecologist's Viewpoint

Dear Editor, I would like to echo the preferred gynecological surgical approach during the COVID-19 pandemic recently reported by Khoiwal and Chaturvedi in this Journal.[] Even though there is no evidence of SARS-CoV-2 virus present in surgical smoke, transmission through pneumoperitoneum, intubation aerosols, face masks, and blood transmission is still possible.[] Numerous papers or recommendations of care advise surgeons in performing open or laparoscopic surgeries during the COVID-19 pandemic.[] In the current situation, hospital beds in many hospitals are overloaded with COVID-19–infected patients, and elective surgeries are reduced.[] Hong Kong also similarly suffers, and many women with fibroids and adenomyosis were not treated surgically in hospitals. This letter presents an alternative surgical treatment of fibroids and adenomyosis in women in times of COVID-19. It is the noninvasive high-intensity focused ultrasound (HIFU) ablation for fibroids and adenomyosis, with good treatment outcome.[] Patients can also be treated as day surgery in a clinic.[] HIFU ablation advantages include day-only surgery, bloodless, no need for pneumoperitoneum, early postoperative recovery, no need for hospital stay, and fewer complications. Thus, it may significantly reduce the risk of viral transmission because it is without blood loss, pneumoperitoneum, and general anesthesia while working in a clinic. The clinic we set up in Hong Kong has successfully treated more than 150 patients during the year of the COVID-19 pandemic. Our experience is further endorsed by HIFU centers in China and Asia Pacific countries where HIFU services are available. This ongoing pandemic and possible future viral pandemic show that this noninvasive HIFU treatment for fibroids and adenomyosis should be recommended wherever the service is available. Finally, our clinic's current experience shows that HIFU ablation for fibroids or adenomyosis does not have an increased risk of transmission of SARS-CoV-2, provided all preventive measures are taken by staff within the clinic and theater. HIFU ablation should be the preferred mode of treatment in the future, especially in a pandemic when running short of hospital beds. Financial support and sponsorship Nil. Conflicts of interest Prof. Felix Wu Shun Wong, an editorial board member at Gynecology and Minimally Invasive Therapy, had no role in the peer review process of or decision to publish this article. Dr. Thomas Li declared that there is no conflict of interest in writing this letter. REFERENCES - 1. Khoiwal K, Chaturvedi J. Gynecological surgeries during COVID-19 pandemic: A laparoscopist's viewpoint Gynecol Minim Invasive Ther. 2021;10:69–70 - 2. Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes Emerg Microbes Infect. 2020;9:386–9 - 3. Chiofalo B, Baiocco E, Mancini E, Vocaturo G, Cutillo G, Vincenzoni C, et al Practical recommendations for gynecologic surgery during the COVID-19 pandemic Int J Gynecol Obstet. 2020;150:146–50 - 4. Mallick R, Odejinmi F, Clark TJ. Covid 19 pandemic and gynaecological laparoscopic surgery: Knowns and unknowns Facts Views Vis Obgyn. 2020;12:3–7 - 5. Shui L, Mao S, Wu Q, Huang G, Wang J, Zhang R, et al High-intensity focused ultrasound (HIFU) for adenomyosis: Two-year follow-up results Ultrason Sonochem. 2015;27:677–81 - 6. Zhang L, Wong FW. A high-intensity focused ultrasound surgery theater design in a private clinic Gynecol Minim Invasive Ther. 2020;9:1–5