Laparoscopic Multibipolar Radiofrequency Myolysis for Symptomatic Myomas in 10 Steps

Abstract

ObjectiveTo describe a minimal invasive 10-step technique of laparoscopic multibipolar radiofrequency myolysis for symptomatic myomas. DesignA step-by-step video demonstration of the technique SettingA woman with symptomatic FIGO 5 myoma of 60 mm of diameter, confirmed by magnetic resonance imaging. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionsApproximately 30% of women of child-bearing age with myomas will present with symptoms (1) that include chronic pelvic pain, abnormal uterine bleeding or infertility (2-3). Data regarding fertility preservation and obstetrical outcomes suggest that radiofrequency myoma ablation may offer an alternative to existing treatments for women who desire future fertility (4). The local institutional review board stated that approval was not required because the video describes a technique and not a clinical case. In our center, all radiofrequency indications are discussed during a monthly multidisciplinary myomas meeting.This video presents the procedure divided into the following 10 steps: planning of the surgery; materials; installation; laparoscopic exploration; transvaginal ultrasound examination; visual and transvaginal ultrasound guided transparietal puncture of the myoma; control of the applicators’ position; radiofrequency myolysis; end of myolysis, applicators removal; final check and additional procedures. ConclusionRadiofrequency myolysis is a simple and reproductible procedure that can be offered as an alternative to myomectomy (5). This video presents 10 steps to make the procedure easier to adopt and to reduce its learning curve.