Evo Terra (Host): This is Health Talk with the Valley Health System, presented by the Valley Health System. I'm Evo Terra, and with me is Dr. Sonnie Kim, a minimally invasive gynecology surgeon as we talk about Sonata radiofrequency fibroid ablation, what it is, who it can help, and how this minimally invasive approach may change the way many women manage uterine fibroids. Dr. Kim, thanks for joining me today.

Sonnie Kim, MD: Thank you for having me.

Host: I don't believe I'm going to have to say this twice, but tell me what this is, a Sonata radiofrequency fibroid ablation. What is that?

Sonnie Kim, MD: So, Sonata is just a name of the company. The fibroid ablation is—a fibroid is so common in women 20 to 50. About nine women out of 10 will have these fibroids. Some of them, two to three people out of those nine will have symptoms. So, that's a fibroid, benign tumor. And an ablation is you put the thermal energy, or pretty much in a layman's term, you burn the targeted tissue. So, we're trying to kind of make it smaller and make it bleed less.

Host: Understood. Thank you for that clarification there. So, using radio waves to ablate or fry or freeze or whatever word we want to use for something—

Sonnie Kim, MD: Burning.

Host: Burning, that's the word I was looking for. So, used for fibroid tumors. Is that the only use for it?

Sonnie Kim, MD: Yes.

Host: Got it. So, we fix the fibroid tumors. Now, talk to me a little bit more about the fibroid tumors for just a moment. You said that they're benign.

Sonnie Kim, MD: Yeah, they're benign. And it's very, very common. And not everyone with the fibroids will have problems. But if you're going to have a problem, it will be heavy bleeding, irregular bleeding, cramping, so that you can't even go to work or it can be a mass effect. So, the fibroid is so big enough, like the size of my fist sitting on top of the bladder, and you can leak urine. Or if it is constricting the rectum area, you can have a severe constipation. So, every woman has a different way of presenting symptoms with the fibroids.

Host: Understood. So before we had this radiofrequency ablation procedure, what did we do? What did gynecology surgeons do prior to this?

Sonnie Kim, MD: We always use the medication first, so step-by-step approach. We can be on the birth control pills, or there is a medication that can mimic our body to go through the menopause to at least stop the growth of the fibroid. And then, that's a medication. The next level will be more of a procedure level, and you can do the myomectomy, that's the removal of the fibroids, or the hysterectomy, that's the removal of the fibroid with the uterus altogether.

And also, interventional radiologists can do the uterine artery embolization. They can throw the clots through those fibroids to cut off the circulation to shrink it. So, there are many, many different ways of doing it.

Host: Okay, great. That's helpful to know. So, what's the big difference between this using radiofrequency to do it versus those other procedures?

Sonnie Kim, MD: The Sonata is we do everything in the vagina. So, we actually put the very high resolution ultrasound into the lining of the uterus. And then, we do the ultrasound while patient is under anesthesia. And we target that fibroid and then put the electrode and burn those targeted tissues.

So, there's no incision compared to the myomectomy or hysterectomy. And that's why the thing that you do, you go back to work next day pretty much. The downtime is very, very short. Some anesthesia recommends the 24-hour downtime because of the anesthesia issue. But procedurally, you don't have that much downtime.

The myomectomy, it is a surgery. Yes, you can do it vaginally. But most of the myomectomies are done with a small incision through the laparoscopy or a large incision with a laparotomy. And hysterectomy also can be done so many different ways.

Host: Right. Okay, great. So, talk about minimally invasive. I mean, there's like no invasion. You're not opening up anything at this particular model.

Sonnie Kim, MD: There you go. We're using the vagina through the scope.

Host: Yeah. That's great. So, which women are the best candidates for this type of procedure?

Sonnie Kim, MD: The one who wants to preserve the uterus. So remember, the hysterectomy is the most definitive treatment for the symptomatic fibroids. But if the patient wants to preserve the uterus, then there's a fibroid radiofrequency ablation or myomectomy. And then, you have to choose pros and cons of each option, and you make the informed decision.

Host: So, I'm assuming one of the pros of using this radiofrequency ablation is you're back to work the next day or whatever you want to do with no downtime unlike other one. Are there some cons we should be aware of?

Sonnie Kim, MD: Actually, it will shrink over the time period, one to three months. So, you will not see the dramatic, relief of a bleeding or a mass effect that I talked about right away, because it will take a time to shrink the fibroids after the burning effect is done. Unlike myomectomy, you are removing the fibroid in its entirety. However, the cons of the myomectomy will be downtime for four to six weeks.

Host: Yeah, that makes sense. And yeah, we have to shrink the fibroid and it takes some time for it to go. Got it. So, you've already said that recovery time for this is let the anesthesia wear off pretty much for the other one.

Sonnie Kim, MD: Yes.

Host: Is there a restriction on like how big a fibroid can get to where we don't want to wait that amount of time? We need to get it out right away. Is that something a doctor chooses or is that the patient making that decision?

Sonnie Kim, MD: The recommendation is up to five centimeter of the fibroid. But I've done eight centimeters, so you just have to seek the doctor who is familiar with these procedures so that you can get the best benefit out of it. And also, the location of the fibroids are very, very important. So if the fibroids are outside of the uterus, just hanging through the thread, we call it pedunculated fibroid. It is not suitable with the Sonata radiofrequency because we're going through the cervix within the uterus. We're trying to find the fibroids that is causing bleeding, you know, the cramping, all these issues. So if it is, like, kind of hanging out of the uterine wall, then it will not be the proper procedure.

Host: Yeah, that's when you need to do something else for it. Okay. We've talked a little bit about cons, but let's talk about risks. Are there any?

Sonnie Kim, MD: Yeah, the thing is that no procedure is entirely without a risk. However, there's no surgical incision. So, there's no, like, infection risk and then blood loss, transfusion is extremely low. Anesthesia, we do it very light sedation, so anesthesia-related issues is very low. And the organ damage, like a bladder and the bowel, is very low. Because this Sonata equipment itself has a safety feature so that I don't throw this heat into the bladder or the bowel. So, it's a very, very safe procedure, I think. Yeah.

Host: I'm going to try to put myself in the shoes of a woman who's struggling with fibroid symptoms right now, which is going to be difficult for me to do, but I'm going to try. What are the signs or the symptoms or situations that should prompt me to go seek evaluation and specifically ask these questions about this new procedure?

Sonnie Kim, MD: So, heavy bleeding and painful period or painful intercourse or urinary incontinence, when you go to the gym, you want to run and then you leak urine or the severe constipation. Those are the main things. Or infertility. Yes, because sometimes if the fibroids are within the lining of the uterus, the embryo cannot rest on the lining of the uterus.

Host: Last question. If someone was interested in what we had to say today and they're curious about this, where do they start the conversation? With their GP, with their OB-GYN? What should they do?

Sonnie Kim, MD: A lot of people start with a GP, the general practitioner, and they will refer the patients to the gynecologist, and not all gynecologists are equipped to do this procedure. So, you need to find out if the gynecologist does it. But I think a consultation with a general gynecologist will be the first step to do.

Also, there is a Sonata website by the company that will tell you which doctor does this Sonata procedure in each area. So in my case, the reason why I started this procedure was my patient said, "Oh, yeah, I had to go to UCLA." So, I said, "Well, what happened?" There was none in Nevada, actually. So, I was the first person who performed the Sonata radiofrequency ablation, yeah, in the state of Nevada.

Host: Wow. Well, that is very good. All right there, first mover. Anything you'd like to add that we didn't cover today?

Sonnie Kim, MD: About the pregnancy. So, we always tell the patient— So, remember, I told you the Sonata is good for the people who want to preserve the uterus. So, it can be for the future pregnancy or it can be just their personal belief. So, I don't want to have a major surgery. But if it is a pregnancy desired case, then I always tell the patient to wait for six months after the ablation.

And then, the study came out, there was a live birth after the Sonata ablation. And there's no uterine rupture or placenta abnormalities that required an automatic hysterectomy at the time of a C-section and the stillbirth. So, those three things were very low, which are high in the patient who had a myomectomy. If you had a myomectomy, you have to have a C-section at 37 weeks. That puts at a high risk for the placenta issue, like placenta previa or the accreta and, yeah, another surgery.

Host: Yeah. Very helpful for those that want to keep—you know, you still haven't had your all your kids yet, you can keep it that way. It's a wonderful thing. Dr. Kim, this has been a fascinating conversation. Thanks for spending time with me today.

Sonnie Kim, MD: Thank you so much for having me.

Host: Once again, that was Dr. Sonnie Kim. For more information, go to valleyhealthsystemlv.com. If you enjoyed this episode, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Evo Terra. This has been Health Talk with the Valley Health System, presented by the Valley Health System. Thanks for listening.

Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks with any surgical procedure. Talk with your doctor about these risks and find out if this procedure is right for you.