Why do some surgeons object to HIFU?
The objections fall under four headings: the fibroid stays in place and may recur, no tissue sample is obtained, the method is applied to unsuitable patients, and the claim that it is "unproven". The first three are real limitations, stated openly on this site and managed through patient selection. The fourth does not match meta-analyses, guideline appraisals and series of hundreds of patients. Surgery and HIFU are not rivals but different tools for different fibroids.
Why we wrote this page
Some of the most-read Turkish texts about HIFU come from surgeons who criticise it. That is a natural debate, and patients should hear both sides. Here we relay the criticisms without softening them and set the evidence, with its source, against each. Our aim is not to defend HIFU but to let you decide with information.
Criticism 1: "The fibroid stays and recurs"
The true part: HIFU does not remove the fibroid; the inactivated tissue shrinks over months but may not vanish entirely, and a proportion of patients need reintervention. The missing part: fibroid disease can also recur after myomectomy; recurrence is a possibility with every uterus-sparing method. The decisive factor is the ablation ratio achieved in the first session.
Long-term series report reintervention after HIFU and identify a low ablation ratio as an independent risk factor; recurrence is lower in patients who reach a high ablation ratio.
Reintervention rates vary markedly with centre experience and patient selection.
Source: 2024 · International Journal of Hyperthermia2022 · Frontiers in Medical Technology
Criticism 2: "There is no tissue diagnosis"
This criticism is valid and is a real limitation of HIFU: the procedure yields no tissue sample. HIFU is therefore not appropriate for masses whose imaging is inconsistent with a fibroid, that grow rapidly, or that appear after menopause; those patients are referred for surgical evaluation. The limitation is a matter of patient selection, not of the method, and is stated on our eligibility pages.
Criticism 3: "It is done on unsuitable patients"
This is a criticism of the operator, not of the method, and applies to every method. The literature describes limited results in patients whose fibroids cannot be seen on ultrasound, lie behind bowel or bone, or are very numerous and very large. Not offering HIFU to those patients is part of the method.
In large ultrasound-guided HIFU series, patient selection and preparation (including bowel manipulation) have been associated with technical success.
These series are single-centre; results depend on centre experience.
Source: 2020 · Taiwanese Journal of Obstetrics and Gynecolo
Criticism 4: "There is no evidence"
This claim does not match the evidence. Systematic reviews and meta-analyses show symptom improvement and volume reduction after focused ultrasound in symptomatic fibroids; bodies such as NICE have appraised the method, and comparative studies report its safety profile. The evidence has limits too: randomised comparisons for ultrasound-guided HIFU are few, and most long-term data are observational. "Limited evidence" and "no evidence" are not the same thing.
Systematic reviews and meta-analyses report significant improvement in symptom scores and low serious-complication rates after focused ultrasound; guideline appraisals consider the method acceptable with appropriate patient selection.
Randomised data mostly concern MR-guided systems; direct transfer to ultrasound-guided HIFU requires care.
Source: 2022 · International Journal of Hyperthermia2021 · Frontiers in Oncology2011 · NICE (İngiltere Ulusal Sağlık ve Bakım Mükem2021 · Obstetrics & Gynecology — klinik guideline
Conclusion: different tools, not rivals
Surgery removes the fibroid and provides a tissue diagnosis; it carries recovery time and operative risks. HIFU inactivates the fibroid without an incision; the chance of recurrence and the absence of tissue diagnosis are its limits. The right question is not "which is better" but "which is more suitable for this fibroid and this patient". The comparison pages on this site address exactly that question.