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. 2025 Oct 3;104(40):e42212. doi: 10.1097/MD.0000000000042212

Advancing understanding of HIFU in uterine fibroids: A meta-review on postoperative recovery and surgical wound healing

Wei-Te Cao a, Zhong-Hua Peng b, Ru-Qian Wang a, Hong Luo a,*
PMCID: PMC12499734  PMID: 41054082

Abstract

Background:

This meta-analysis provides a novel perspective on postoperative wound recovery after uterine fibroid surgery, focusing on pain, menstrual blood loss, fibroid volume, complications, and quality of life.

Methods:

A comprehensive search for relevant studies was performed in the PubMed, Web of Science, China National Knowledge Infrastructure, the Cochrane Library, Embase, and Google Scholar databases. Various combinations and permutations of the keywords “uterine fibroid” and “high-intensity focused ultrasound (HIFU)” were used to retrieve studies. Articles published until April 2024 were eligible for inclusion. The titles and abstracts of all retrieved articles were screened to assess their relevance. Subsequently, the full texts of the selected articles were reviewed to determine their eligibility for inclusion in the meta-analysis.

Results:

The analysis reveals that HIFU can minimize pain and improve the quality of life of patients with uterine fibroids. Specifically, the observational group treated with HIFU experienced reduced pain, decreased menstrual blood loss, fibroid volume, and complications.

Conclusion:

Our findings serve as valuable reference points for clinicians in treating uterine fibroids.

Keywords: high-intensity focused ultrasound, postoperative complications, quality of life, uterine fibroid

Key points.

  • This meta-analysis compared the outcomes during postoperative recovery between the traditional surgical (control) group and high-intensity focused ultrasound (HIFU)-assisted surgical (observation) group.

  • The HIFU technique was found superior in terms of pain alleviation, menstrual blood loss, decrease in fibroid volume, and lower incidence of complications, ultimately enhancing patients’ quality of life.

  • Our study provides compelling evidence of the efficacy of HIFU technique, offering valuable insights for clinicians to provide personalized treatments for uterine fibroids.

1. Introduction

Benign gynecological conditions, as an underestimated health risk, remain burdensome to the females, especially in the under-developed countries.[1] Uterine fibroids (leiomyomas or myomas) are a commonly occurring benign gynecological condition in women of reproductive age.[2] These are typically detected by clinical or imaging examinations, and in a large proportion of cases, uterine fibroids are incidentally detected.[3] Despite being a benign condition, uterine fibroids can result in heavy menstrual bleeding, pelvic pain, and reproductive disorders, significantly impacting the quality of life.[3] There are several risk factors for uterine fibroids including genetic factors, race, age, and early menarche.[4] Doppler imaging is commonly used for routine assessment of uterine fibroids in clinical practice.[5] Patients with intractable symptoms require surgical treatment such as uterine fibroid ablation, myomectomy, or even hysterectomy in severe cases. The treatment strategy is based on several factors such as the symptoms, size, and location of fibroids, the patient’s age as well as the desire to preserve fertility.[3]

Owing to technological advances, ultrasound technologies play a pivotal role in the clinical management of uterine fibroids, including clinical assessment and treatment planning.[6] From aiding in the accurate localization and sizing of fibroids to monitoring treatment response and minimizing procedural risks, ultrasound has become indispensable in the management of this condition.[7] However, the true frontier in uterine fibroid treatment lies in the innovative application of high-intensity focused ultrasound (HIFU) technology. HIFU offers a noninvasive, outpatient procedure that uses focused ultrasound waves to thermally ablate fibroid tissue while preserving the surrounding healthy structures.[8,9] This precise energy targeting allows for the selective destruction of fibroids, leading to symptom relief and preservation of fertility in many cases.[10] As an alternative to surgical interventions like hysterectomy or myomectomy, HIFU presents a promising avenue for patients seeking minimally invasive options with shorter recovery times and reduced risks.[11]

By leveraging the capabilities of ultrasound technology, clinicians can offer personalized care pathways tailored to each patient’s needs, ultimately improving outcomes, and enhancing the quality of life for individuals affected by this common gynecological condition. By synthesizing findings from a range of clinical studies, we seek to elucidate the efficacy, safety, and clinical outcomes associated with HIFU treatment. Despite the abundance of studies on the efficacy and safety of HIFU in treating uterine fibroids, few have focused on postoperative recovery. In this meta-review, we provide a comprehensive update on HIFU in uterine fibroids, specifically examining surgical wound healing.

2. Methods

2.1. Research strategy

A comprehensive search for relevant studies was performed in the PubMed, Web of Science, China National Knowledge Infrastructure, the Cochrane Library, Embase, and Google Scholar databases. Various combinations and permutations of the keywords “uterine fibroid” and “HIFU.” We modified the search strategy for different databases. On PubMed, the strategy was: ((Leiomyoma ma[Mesh]) or (fibroid*[Title/Abstract]) or (*myomas[Title/Abstract])) and ((HIFU[Title/Abstract]) or (focused ultrasound[Title/Abstract]) or (Magus[Title/Abstract])) or (High-Intensity Focused Ultrasound Ablation[Mesh]) and ((Hysterectomy[Title/Abstract]) or (uterotomy[Title/Abstract]) or (mastectomy[Title/Abstract]) or (hysterosomyomectomy[Title/Abstract]) or (myomectomy[Title/Abstract])). Articles published until April 2024 were eligible for inclusion. The titles and abstracts of all retrieved articles were screened to assess their relevance. Subsequently, the full texts of the selected articles were reviewed to determine their eligibility for inclusion in the meta-analysis. This meta-analysis was conducted according to the PRISMA guidelines.

2.2. Inclusion and exclusion criteria

Studies that qualified the following criteria were eligible for inclusion in the meta-analysis.

Inclusion criteria: (1) patients with uterine fibroids should have received traditional surgical operations; (2) clearly defined observation (HIFU-assisted traditional surgeries) and control (only received traditional surgeries) groups and a clear indication of whether HIFU operation was received; (3) study design: randomized clinical trials, cohort studies, and observational studies; (4) various types of surgeries for uterine fibroids were included in the control group for comparison as a whole with the observation group.

Exclusion criteria: (1) studies in which no surgical treatment was carried out in patients with uterine fibroids; (2) lack of differential analysis to compare the use of the HIFU technique versus traditional operations; (3) lack of availability of full-text articles; (4) abstracts, meeting presentations, case reports, reviews, and duplicate publications.

2.3. Data extraction and outcome measure

The following parameters were evaluated: (1) visual analog scale (VAS) score for pain; (2) cases with decreased menstrual blood loss; (3) fibroid volume; (4) rate of postoperative complications; and (5) quality of life. The effect size was reported as a standardized mean difference or risk ratio.

2.4. Publication bias assessment, risk of bias assessment, and statistical analysis

Meta-analysis was performed using the RevMan 5.4 software. Heterogeneity among the included studies was evaluated using the Q-test (α = 0.1) and indicated by the I2 value. An I2 value of <50% was considered indicative of low heterogeneity. In case of low heterogeneity, a fixed-effect model was used for meta-analysis, while a random-effect model was used in case of significant heterogeneity. In addition, sensitivity analysis was performed to assess the stability of the results. The effect of potential publication bias on the results of the meta-analysis was assessed using the funnel plot and Egger test. The risk of bias among the included studies was assessed using the Cochrane risk of bias tool. P values < .05 were considered indicative of statistical significance for all analyses.

3. Results

3.1. Study selection

A total of 583 publications were retrieved on search of the databases (Fig. 1): China National Knowledge Infrastructure (82 publications), PubMed (108 publications), Web of Science (84 publications), the Cochrane Library (59 publications), Embase (73 publications), and Google Scholar (177 publications). Of these, 88 publications were excluded due to duplication. After a screening of the titles and abstracts, an additional 293 publications were excluded as these did not meet the selection criteria. After a round of quality inspections, 176 publications were found to be irrelevant to our research theme. Finally, a total of 18 studies[12–29] were included in this meta-analysis.

Figure 1.

Figure 1.

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Flowchart of the meta-analysis under the PRISMA guideline.

The diagnosis of uterine fibroids was based on transabdominal and transvaginal ultrasound and magnetic resonance imaging.[30] The demographic characteristics of the patients in the 18 studies are summarized in Table 1, encompassing a total of 1874 cases. Among these cases, 926 received surgical treatment in the control group, while 948 also received HIFU in addition to surgical operations in the observation group with even distribution of age across groups.

Table 1.

Demographic features of the study population in the included studies.

Research Control group Observation group
n Mean age n Mean age
Wang et al, 2017[12] 35 28.16 ± 3.01 35 28.42 ± 3.04
Xin et al, 2024[13] 50 37.7 ± 5.2 50 37.9 ± 5.3
Wang, 2023[14] 106 40.88 ± 6.35 85 42.73 ± 5.74
Wu et al, 2019[15] 25 29.55 ± 2.28 30 31.37 ± 2.24
Chen et al, 2018[16] 40 44.58 ± 6.72 40 44.12 ± 6.84
Li et al, 2017[17] 69 37.5 ± 2.1 69 38.6 ± 2.3
Liu et al, 2012[18] 20 42.14 ± 3.21 20 40.21 ± 3.08
Wang, 2020[19] 60 40.07 ± 3.63 60 39.87 ± 4.12
Chen et al, 2017[20] 35 28.61 ± 3.36 35 28.42 ± 3.12
Chen et al, 2016[21] 54 40.12 ± 4.93 54 38.67 ± 4.67
Zhang et al, 2023[22] 35 47.94 ± 3.36 35 48.36 ± 3.91
Zhao et al, 2016[23] 50 39.17 ± 6.0 50 37.25 ± 5.4
Fan, 2022[24] 50 42.36 ± 4.91 44 42.50 ± 5.92
Bao et al, 2012[25] 150 44.5 ± 11.5 150 43.5 ± 11.5
Tang, 2020[26] 23 18–50 30 18–50
Liu 2019[27] 35 37.23 ± 2.33 35 37.39 ± 2.18
Zhu et al, 2015[28] 46 31.4 ± 5.1 76 32.5 ± 5.0
Huang et al, 2020[29] 43 35.0 ± 2.7 50 36.0 ± 2.2
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3.1.1. Quality assessment result

Figures 2 and 3 illustrate the risk of bias assessment using the Cochrane tool (RevMan 5.4). The risk of selection and detection bias was unclear in most studies, but overall, the risk of bias in the included studies was relatively low.

Figure 2.

Figure 2.

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Risk of bias graph: judgements about each risk of bias item presented as percentages across all included studies.

Figure 3.

Figure 3.

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Risk of bias summary: judgements about each risk of bias item for each included study.

3.2. Effect of HIFU treatment on reducing pain

The included studies reported variable effects of HIFU treatment in alleviating pain, as assessed by VAS scores. As shown in Figure 4, HIFU treatment significantly reduced pain VAS scores compared to the control group (P < .00001).

Figure 4.

Figure 4.

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The difference in VAS score in the observation and control groups. VAS = visual analog scale.

3.3. Effect of HIFU treatment on menstrual flow

Menstrual blood loss (MBL) is a key indicator for evaluating the effectiveness of surgical interventions, particularly for uterine fibroids. Figure 5 demonstrates that HIFU treatment significantly reduces MBL to a greater extent post-surgery compared with the control group, resulting in a higher proportion of patients achieving controlled MBL at a lower level (P < .05). This indicated the superiority of HIFU in reducing menstrual bleeding.

Figure 5.

Figure 5.

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The difference in the number of cases with reduced menstrual blood loss between the observation and control groups.

3.4. Effect of HIFU treatment on uterine fibroid volume

Assessing uterine fibroid volume is essential for evaluating treatment efficacy. A reduction in volume indicates successful intervention, correlating with symptom relief and improved quality of life. Monitoring volume changes aids in tracking treatment response, guiding management decisions, and potentially improving surgical outcomes.[31] Evaluation of uterine fibroid volume 6 months posttreatment revealed a significant decrease in fibroid volume among patients receiving HIFU treatment compared to those in the control group (Fig. 6). This indicated a superior efficacy of HIFU in fibroid elimination, facilitating a swifter recovery for patients within the 6-month period.

Figure 6.

Figure 6.

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The difference in uterine fibroid volume between the observation and control groups.

3.5. Effect of HIFU treatment on postoperative complications

The postoperative complications of uterine fibroid treatment include endometrial proliferation, tubal obstruction, or even uterine rupture. It is imperative to maintain vigilant postoperative monitoring and implement appropriate management strategies to address these potential complications and enhance patient outcomes.[32] The results of the meta-analysis showed a significantly lower incidence of postoperative complications after HIFU treatment (P < .00001) (Fig. 7). In this meta-analysis, complications manifest as various symptoms, including hematuria, subcutaneous soft tissue injury, vaginal bleeding, fever, lower abdominal pain, vaginal discharge, and others.

Figure 7.

Figure 7.

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The difference in postoperative complications between the observation and control groups.

3.6. Effect of HIFU treatment on quality of life

The uterine fibroid symptom and health-related quality of life (UFS-QOL) questionnaire is a validated tool to assess symptom severity and its impact on quality of life among women with uterine fibroids. It covers various domains including symptom severity, energy/mood, control, self-consciousness, and sexual function, providing a comprehensive evaluation of the physical and emotional impact of fibroids on patients’ lives.[33] Based on the data from the UFS-QOL questionnaire, patients in the observation group who received HIFU treatment exhibited a significant improvement compared to the control group (P < .00001) (Fig. 8).

Figure 8.

Figure 8.

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The difference in UFS-QOL score between the observation and control groups. UFS-QOL = uterine fibroid symptom and health-related quality of life.

3.7. Publication bias

The funnel plots for publication bias are shown in Figure 9A–E. The funnel plot indicates that most data points fall within the funnel, suggesting a low risk of significant bias. However, although the funnel plot initially shows no obvious publication bias, it is important to note the potential for systematic bias. Additionally, the results of Egger test were not significant (P = .7878), further indicating that the risk of bias in the studies we included is relatively low. We further discuss the potential limitations of these findings in the discussion section.

Figure 9.

Figure 9.

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Sensitivity analysis of the outcome differences: (A) VAS scores, (B) number of cases with reduced menstrual blood loss, (C) uterine fibroid volume, (D), postoperative complications, and (E) UFS-QOL score. UFS-QOL = uterine fibroid symptom and health-related quality of life, VAS = visual analog scale.

4. Discussion

HIFU is a novel, minimally invasive treatment for uterine fibroids.[34] In this meta-analysis, we compared the effectiveness of HIFU treatment with that of conventional treatment.

Traditional surgical approaches for uterine fibroid treatment often involve invasive procedures with large abdominal incisions, leading to prolonged recovery times and increased risk of complications.[35] In contrast, HIFU treatment utilizes focused ultrasound waves to precisely target and ablate fibroid tissue without the need for surgical incisions.[33,35] This technique uses the emitted energy to heat tissue rapidly, ensuring minimal vascular interference, and promotes desired cellular responses like inflammation and fat necrosis.[36] In this meta-analysis, we compared this technique with traditional surgical procedures, paying particular attention to postoperative wound recovery. The outcome measures were VAS score to assess pain, menstrual blood loss, uterine fibroid volume, and the occurrence of complications, reflecting the surgical impact. Additionally, we examined UFS-QOL scores to evaluate the patient’s quality of life following the procedure.

Firstly, we observed a significant reduction in pain after HIFU treatment utilizing the VAS scores,[37] which is consistent with previous research.[11] Pain reduction not only improves patient quality of life but may also reduce reliance on analgesic medications, lowering healthcare costs, and mitigating psychological and emotional distress associated with chronic pain.[38] Furthermore, HIFU treatment significantly reduced MBL. By reducing fibroid volume and improving endometrial status, HIFU effectively diminishes menstrual bleeding.[39] This alleviates complications such as anemia and irregular menstruation associated with heavy menstrual bleeding and improves the quality of life and overall health of patients. Uterine fibroid volume is another parameter for assessing the treatment efficacy. In this meta-analysis, the HIFU group showed a significant decrease in uterine fibroid volume compared to the control group, suggesting a significant impact of HIFU on the tumorigenic characteristics of uterine fibroids,[40] leading to gradual shrinkage or disappearance of tumors, with lower invasiveness and faster recovery times, providing patients with a safer and more effective treatment option.[41]

Additionally, HIFU treatment was associated with a significantly lower incidence of posttreatment complications. Infection, endometrial proliferation, and tubal obstruction are common postoperative complications of uterine fibroid treatment.[42] The noninvasive nature and precise treatment targeting of HIFU contribute to a lower incidence of these complications, further enhancing treatment safety and efficacy.[41] Moreover, HIFU treatment significantly improved the quality of life of patients, as reflected in the significant increase in UFS-QOL scores. This indicates that HIFU not only relieves symptoms and improves physiological health but also helps enhance psychological health and social functioning, thereby comprehensively improving overall quality of life.[43]

4.1. Strengths and weaknesses

This meta-analysis revealed several strengths of HIFU treatment over traditional surgical treatment. For example: compared to existing literature, our study provides an in-depth analysis of postoperative recovery following HIFU treatment for uterine fibroids. Previous studies, such as the meta-analysis comparing the effects of HIFU and surgical intervention for symptomatic uterine fibroids, primarily focused on the comparison of these 2 treatment modalities in terms of symptom relief, quality of life improvement, recovery time, and complication rates.[44] The findings indicated that HIFU performed better in reducing symptom severity and shortening hospital stays, while showing comparable outcomes to surgery regarding adverse events and pregnancy outcomes. Additionally, another study examined the reproductive and obstetric outcomes of HIFU, uterine artery embolization, and transcervical radiofrequency ablation, highlighting HIFU as a promising noninvasive treatment method that outperforms surgery in some aspects but shows similar recurrence rates for symptoms.[45] Lastly, research on the long-term outcomes and risk factors for re-intervention after HIFU emphasized the acceptable overall re-intervention rates associated with HIFU technology.[46]

Despite these studies providing valuable insights into the efficacy of HIFU, they did not thoroughly investigate the impact of postoperative wound healing and related complications. Our meta-analysis fills this gap by focusing on wound-related complications during the postoperative recovery process, highlighting the potential advantages of HIFU in promoting postoperative wound healing. By integrating the latest research data up to April 2024, our findings offer new perspectives for clinicians treating uterine fibroids, helping them to more comprehensively evaluate the effectiveness of HIFU, particularly in terms of postoperative recovery.

However, this study has some weaknesses that need to be considered. First, there were significant differences in the statistical methods employed across studies, and some key evaluators lacked consistency, which affected their effectiveness as data sources. Additionally, the included data only reflect clinical findings and do not adequately assess the prognostic impact of HIFU. Therefore, further research is needed to explore the long-term effects of HIFU. Moreover, conducting health economics assessments would help provide a more comprehensive evaluation of the added value of HIFU in other aspects. Furthermore, the literature included in this study was published and retrievable before April 2024, so studies published after April 2024 were not included, which may impact the conclusions of this research. The latest research findings may significantly affect our results. Therefore, we will incorporate the latest research outcomes in future studies to validate the conclusions of this research and enhance its applicability and reliability.

5. Conclusion

In conclusion, our findings demonstrate the multifaceted benefits of HIFU in uterine fibroid treatment, including pain relief, reduction in menstrual blood loss, shrinkage of fibroid volume, decrease in complication rates, and enhancement of quality of life. Thus, HIFU seems to be a safe and effective treatment option for uterine fibroids. Our findings may serve as valuable reference points for clinicians in treating uterine fibroids. However, further long-term follow-up studies are required to validate these findings and further refine the treatment strategies to maximize the advantages of HIFU in uterine fibroid treatment.

Acknowledgments

We thank Medjaden Inc. for its assistance in the preparation of this manuscript.

Author contributions

Conceptualization: Wei-Te Cao.

Data curation: Wei-Te Cao.

Formal analysis: Wei-Te Cao, Zhong-Hua Peng.

Investigation: Zhong-Hua Peng.

Methodology: Zhong-Hua Peng.

Project administration: Ru-Qian Wang.

Resources: Ru-Qian Wang.

Software: Ru-Qian Wang.

Supervision: Hong Luo.

Validation: Hong Luo.

Visualization: Hong Luo.

Writing – original draft: Wei-Te Cao, Zhong-Hua Peng, Ru-Qian Wang.

Writing – review & editing: Hong Luo.

Abbreviations:

HIFU
high-intensity focused ultrasound
MBL
menstrual blood loss
UFS-QOL
uterine fibroid symptom and health-related quality of life
VAS
visual analog scale.

We will strictly abide by the principles of legality and transparency in data use to ensure the correct use and interpretation of research data. We will try our best to avoid data misunderstanding and abuse, and only use the data for research purposes.

We assessed the potential risks that may be involved in the study during the project design stage and took appropriate measures to reduce or manage these risks. We guarantee that participants will not suffer any physical or psychological harm because of participating in the study.

We have taken appropriate measures to protect the privacy of participants’ personal information. We will not disclose any personal information that may lead to the identification of participants. In the research report, we will treat the participants’ information anonymously.

This research project has been approved by Ethics Committee of West China Second University Hospital and operated in strict accordance with ethical standards. In this study, we respect and protect the rights and privacy of participants and ensure the confidentiality of their personal information.

We explained the purpose, process, risks and benefits of the study to all individuals involved in the study orally or in writing, and obtained their informed consent. Participants have the right to know that their participation is voluntary and can withdraw from the study at any time.

The purpose of this statement is to ensure the ethical compliance of research projects and protect the rights and privacy of participants. If you have any further questions or doubts, please feel free to contact us.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Cao W-T, Peng Z-H, Wang R-Q, Luo H. Advancing understanding of HIFU in uterine fibroids: A meta-review on postoperative recovery and surgical wound healing. Medicine 2025;104:40(e42212).

Contributor Information

Wei-Te Cao, Email: 18281628207@163.com.

Zhong-Hua Peng, Email: 872033407@qq.com.

Ru-Qian Wang, Email: 393392314@qq.com.

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