Operative outcomes of combined laparoscopic radiofrequency ablation (RFA) and laparoscopic myomectomy for uterine fibroids

Abstract

To describe the population and assess surgical outcomes of participants undergoing combined laparoscopic radiofrequency ablation (RFA) and laparoscopic myomectomy to treat uterine fibroids. This is a single-arm analysis of data from the ULTRA study, an ongoing multi-center prospective cohort study of women undergoing laparoscopic radiofrequency ablation and/or myomectomy. This is a subgroup analysis of ULTRA participants who underwent combined procedures of laparoscopic RFA and simultaneous laparoscopic myomectomy. We assessed intraoperative complications, blood loss, operative time, and adverse events within 6 weeks of surgery. We also assessed patient reported outcomes, including quality of life (UFSQoL) and sexual function (SHOW-Q) preoperatively and at 6 weeks postoperatively. 34 women underwent a combined laparoscopic RFA and myomectomy procedure. The mean age was 40.5 years (SD 4.4), with a median BMI of 29.0 (CI 23.9-32.9). 25 (74%) of women were Black or African American, 7 (21%) White, 2 (6%) Latina/Hispanic, 1 (3%) Asian, 1 (3%) other. 30 (88%) were employed full time. The mean number of fibroids was 3.8 (SD 2.2), with mean uterine volume of 543.6 ml (SD 378.4) and mean fibroid volume 127.9 ml (SD 108). There were 4 reported perioperative complications. The mean estimated blood loss was 63 mL (SD 72). The mean days for return to work was 12.9 (SD 8.0) and 12.0 (SD 9.0) to return to usual activities. Trends in improvement in all domains of sexual function and quality of life were noted from baseline prior to surgery to 6 weeks postoperatively. Baseline fibroid symptom severity was high with a UFS-QOL score of 66.8 (SD 24.1). Six weeks after surgery, there was significant improvement in symptoms with a mean score of 49.2 (SD 26.3, p=0.04 for change score). The impact of fibroid symptoms on quality of life also improved following surgery. The UFS-QOL scale for self-consciousness improved from baseline 28.6 (SD 30.1) to 44.6 (SD 20.1, p=0.04 for change score) after surgery. In terms of sexual function, orgasm frequency and quality was noted to have a significant improvement from baseline score on the SHOW-Q questionnaire of 59.9 (SD 29.1) to 70.57 (SD 23.9) 6 weeks postoperatively. Laparoscopic RFA has become increasingly used to treat patients with fibroid-related symptoms. With wider adoption of this treatment option, surgeons have expanded beyond offering RFA alone and are now offering combined procedures of myomectomy for specific fibroids, while also performing RF treatment of other fibroids during the same surgery. Our data demonstrate that these combined surgeries provide for a quick recovery with significant improvement in patient reported symptom severity, self-consciousness, and sexual functioning.