Radiofrequency Ablation of an 11cm Posterior Transmural Fibroid

Abstract

Study Objective To document through a case report and video, a successful Laparoscopic Radiofrequency Ablation (Lap RFA) treatment of an 11cm posterior transmural fibroid. Design Video Case Report, 8 months follow up. Setting Hospital OR, Straight Stick Laparoscopy with Laparoscopic Ultrasound and Guidance Mapping. Patients or Participants 29-year-old African American G0 with a one-year history of urinary frequency, urgency, heavy menstrual bleeding and anemia, recently requiring blood transfusion despite COCP's. Preoperative ultrasound imaging showed a 13 × 11 × 9cm uterus with an 11 × 9 × 9cm posterior intramural fibroid. Patient was seeking a minimally invasive, uterine sparing alternative to a myomectomy. Interventions Laparoscopic Radiofrequency Ablation and surgical resection of endometriosis, July 2019, with treatment of one single posterior transmural fibroid, 10 separate radiofrequency ablations, totaling 32minutes of total ablation time. EBL 30cc. No surgical or postoperative complications. Measurements and Main Results Patient reported subjective improvement in urinary frequency, urgency, heavy menstrual bleeding and anemia at 3 months and continued relief at 8 months post-op. 1. Uterus volume shrinkage by 47% by 4 months and remained at 8 months (1287cm^3 to 687cm^3). 2. Fibroid volume shrinkage by 72% by 4 months, and by 79% at 8 months (891cm^3 to 185 cm^3). Conclusion Laparoscopic Radiofrequency Ablation proved to be an effective treatment for fibroid larger than 9cm, in this case an 11 cm posterior intramural fibroid, and resulted in greater than 70% volume reduction and patient symptom relief by 4 months post-op.