11 Sonata transcervical radiofrequency ablation: A look inside

Abstract

The objective of this video is to illustrate the key surgical steps for transcervical ultrasonographic radiofrequency ablation with the Sonata System. Uterine fibroids affect 70-80% of reproductive aged women. Interventions for symptomatic patients include myomectomy, hysterectomy, UAE, and radiofrequency ablation (RFA). Several RFA devices exist on the market. One such device is the sonography-guided Sonata System which is unique in its transcervical approach allowing for incisionless treatment of fibroids (Taub 2017). It can be used to treat fibroids FIGO 1-6 with a radius up to 5 cm (Taub 2017). One and two year post ablative therapy outcomes have been promising. At one year post RFA, mean maximal volume reduction was 63.8%, 95% reported reduction in bleeding, and 97.4% reported symptom improvement (Hudgens 2019, Miller 2019). At two years post Sonata RFA, treatment satisfaction remained 94% with rare need for surgical reintervention (5.5%) (Miller 2019). In this video, we present a patient who underwent Sonata transcervical RFA for a 4 cm intramural fibroid and simultaneous laparoscopic myomectomy for a 4 cm pedunculated fibroid. This allowed for the unique ability to view the external effect on the uterus during use of Sonata. Key surgical steps with Sonata RFA are also reviewed which include:1Cervical dilation2Introduction of Sonata System3Sonographic identification of the target fibroid4Adjust size and shape of Smart Guide overlays5Deploy the introducer6Safety rotation check7Deploy the needle electrodes8Initiate radiofrequency ablation9Withdraw needle electrodes and introducer. Sonata is a simple, minimally invasive treatment option for fibroids.