On the Case: Q&A with Melanie Belt, MD, OBGYN

Dr. Melanie Belt, MD, OBGYN has been practicing for 14 years and is currently Co-Chief of Austin Regional Clinic South Ob/Gyn. Dr. Belt introduced the Acessa procedure to her practice in 2020, and in this Q&A she shares how she counsels patients on fibroid treatment options, offers advice on how to best master the Acessa procedure, and how physicians can address disparities across fibroid treatment and care.

Q. Who is your typical candidate for the Acessa procedure?
A. The Acessa procedure is for someone who has fibroids, has completed childbearing, and who does not want to lose her uterus. When a patient comes in, I want to make sure she knows her options beyond hysterectomy, and I always include the Acessa procedure in the treatment discussion. Of course, as I counsel patients about treatment options, it’s important to stay close to the patient’s specific needs and the size and location of their fibroids. To present the Acessa procedure as an effective option for my patients, the patient must have fibroids that are a bit larger and are within the uterine wall or on the uterine surface. My patients who have ultimately had an Acessa procedure have consistently experienced a positive impact on their quality of life. These women are glad they were able to bounce back very quickly after their treatment, return to their normal life, and have relief from symptoms.

Q. How can you use the Acessa procedure concomitantly with other procedures to treat fibroid patients?
A. Concomitant fibroid treatment procedures will depend on each case. For example, dual procedures could be beneficial for patients who have fibroids that are a range of sizes, or patients with fibroids in multiple locations. You may have a patient that has a pedunculated fibroid, who may also have two or three other intramural fibroids that are 3-4cm, so that patient is a candidate for a dual procedure. I would recommend performing a myomectomy to remove the pedunculated fibroid, and the others can be treated with the Acessa procedure. Or, in the case of someone with a large submucosal fibroid, I would go in via hysteroscopy to remove a portion of the fibroid, and then use the Acessa procedure for the others that are within the intramural muscle.

Q. What are common misconceptions about the Acessa procedure?
A. Where patients are concerned, they can often think that the Acessa procedure is going to be painful, and that it will put them out of work for a long period of time, causing them to be hesitant about the procedure. In reality, the Acessa procedure does neither of those things. Patients can return home the same day and find they can get back to work and life within 4-5 days.1 One of the benefits of the Acessa procedure is the convenience factor, as in most cases the return to normal life is very quick. The Acessa procedure is an option that allows women to have a major problem— their fibroids—taken care of in an outpatient procedure, and they can get back to living their lives within a few days.

Q. What advice or recommendations do you have for your counterparts to help boost education around minimally invasive treatment options for fibroid patients?
A. I think the best way to serve patients is by staying up to date on the latest procedures and advancements. Varied webinars and virtual conferences are offered by device manufacturers like Hologic, and can be accessed while at home, that help physicians stay abreast of recent advancements, ensuring that patients are being offered all of the available cutting-edge treatments. By staying on top of surgical management and new techniques that emerge, we can be certain that we are continuing to offer patients state-of-the-art medical care.

Q. What about educating patients about their options, knowing that certain patients, especially women in the Black community, suffer from inequalities across treatment and care for fibroids?
A. The importance of education and awareness rings true to help reduce and eliminate disparities seen across fibroid treatment within high-risk communities. Women have come into my practice with large, 6cm and 8cm fibroids who were told by previous physicians that they were fine, when they should have been offered treatment options. On the other hand, I recently saw a patient with a 3cm fibroid who was told she needed a hysterectomy. Patients should be taught if they have fibroids that are greater than 2cm, that they should be more aggressive in therapy rather than ‘watching and waiting.’ Education is key in seeing better management in fibroids in Black women, as patients should be provided the tools to advocate for themselves and their bodies in partnership with their physicians.

Q. What advice do you have for a physician who is considering or just starting to offer the Acessa procedure?
A. One of the biggest benefits about the Acessa procedure is the ultrasound visualization and guidance mapping system, which enables the physician to have better visualization from all different points of view during the procedure. If you haven’t used the Acessa procedure before, the use of the ultrasound probe may be new to you – so my advice would be to practice using it as much as you can since it is so essential to having a successful procedure. Being able to master the various probes will allow you to completely treat each fibroid, which directly improves patient outcomes.

1SG Chudnoff, et al. Outpatient Procedure for the Treatment and Relief of Symptomatic Uterine Myomas. Obstetrics and Gynecology,