Making Use of the Tools in the Toolkit: Combined Transcervical Radiofrequency Ablation and Hysteroscopic Myomectomy

Abstract

<h3>Study Objective</h3> To highlight and describe the combined use of radiofrequency ablation and hysteroscopic myomectomy to address symptomatic uterine fibroids. <h3>Design</h3> Video presentation. <h3>Setting</h3> Academic tertiary care center. <h3>Patients or Participants</h3> This is a 41-year-old patient G2P1011 patient with a history of abnormal uterine bleeding and uterine fibroids. Her past surgical history was significant for an exploratory laparotomy for an ectopic pregnancy, a robotic-assisted laparoscopic myomectomy, as well as a 2-staged hysteroscopic myomectomy. <h3>Interventions</h3> Preoperative pelvic ultrasound showed an enlarged uterus with a 4.1 × 3.7 × 5.2 cm FIGO type 1 fibroid extending from the left uterine fundus into the endometrial cavity. The patient opted for a combined procedure of transcervical radiofrequency ablation and hysteroscopic myomectomy to maximize her chances of success; given her prior failed treatments. <h3>Measurements and Main Results</h3> The radiofrequency ablation portion of the case was completed first; with three overlapping zones of ablation completed on the fibroids. The submucosal component of the fibroid was then resected using the resectoscope. The patient tolerated the procedures very well, no complications were encountered. She was discharged on the same day of her procedure with non-opioid analgesics. <h3>Conclusion</h3> Uterine preserving, concomitant use of multi-modality surgery can be considered for patients presenting with symptomatic uterine, including those with significant intramural and submucosal components. Combining minimally invasive tools such as radiofrequency ablation and hysteroscopic myomectomy can offer patients safe and effective alternatives in management of recurrent and recalcitrant leiomyomas.