Successful Laparoscopic Radiofrequency Ablation (Lap RFA) of 10 Cm Adenoma with 2 Year Stability

Abstract

Study Objective To present successful off-label treatment of symptomatic mega Adenoma with Lap RFA for patient desiring to maintain fertility and to present durable 2-year symptom relief and lesion stability post treatment. Design Case Report. Setting Private Practice TX. Patients or Participants 41-year-old African American female G1P0010who originally presented, in May, 2017 as a referral from a fertility specialist for treatment of large adenoma. Pt complained of severe dysmenorrhea and menorrhagia. She had previously undergone several unsuccessful rounds of Clomid. MRI imaging showed an anterior 9.5cm full thickness anterior uterine wall adenoma, with indistinct margins involving the junctional zone. The uterus measured 14cm in total length. There were 3 smaller fibroids noted. She had seen multiple other gyn physicians who had counseled her for hysterectomy, or extensive myomectomy, neither of which would have rendered her able to safely carry a pregnancy. Interventions In July, 2017, after counseling on off label use of Lap RFA for future fertility and off label use on adenoma, the patient received a concomitant procedure including Laparoscopic Radiofrequency ablation with Acessa system and myomectomy. Lap RFA was used to ablate the large anterior adenoma and myomectomy was performed on several smaller pedunculated fibroids. Measurements and Main Results 3 months after the Laparoscopic Radiofrequency Ablation, ultrasound imaging was performed which demonstrated successful shrinkage of the adenoma by 60%. By 6 months, the ultrasound demonstrated 75% reduction in the size of the lesion with sharp margins. Two years later, the area is stable and the patient is pursuing pregnancy. Conclusion For this patient, the off label use of laparoscopic radiofrequency ablation on an adenoma and the off label use for a fertility patient allowed successful treatment of an otherwise untreatable large anterior adenoma involving the entire anterior uterine wall. She is stable 2 years post-op and pursuing fertility. To present successful off-label treatment of symptomatic mega Adenoma with Lap RFA for patient desiring to maintain fertility and to present durable 2-year symptom relief and lesion stability post treatment. Case Report. Private Practice TX. 41-year-old African American female G1P0010who originally presented, in May, 2017 as a referral from a fertility specialist for treatment of large adenoma. Pt complained of severe dysmenorrhea and menorrhagia. She had previously undergone several unsuccessful rounds of Clomid. MRI imaging showed an anterior 9.5cm full thickness anterior uterine wall adenoma, with indistinct margins involving the junctional zone. The uterus measured 14cm in total length. There were 3 smaller fibroids noted. She had seen multiple other gyn physicians who had counseled her for hysterectomy, or extensive myomectomy, neither of which would have rendered her able to safely carry a pregnancy. In July, 2017, after counseling on off label use of Lap RFA for future fertility and off label use on adenoma, the patient received a concomitant procedure including Laparoscopic Radiofrequency ablation with Acessa system and myomectomy. Lap RFA was used to ablate the large anterior adenoma and myomectomy was performed on several smaller pedunculated fibroids. 3 months after the Laparoscopic Radiofrequency Ablation, ultrasound imaging was performed which demonstrated successful shrinkage of the adenoma by 60%. By 6 months, the ultrasound demonstrated 75% reduction in the size of the lesion with sharp margins. Two years later, the area is stable and the patient is pursuing pregnancy. For this patient, the off label use of laparoscopic radiofrequency ablation on an adenoma and the off label use for a fertility patient allowed successful treatment of an otherwise untreatable large anterior adenoma involving the entire anterior uterine wall. She is stable 2 years post-op and pursuing fertility.