Successful Symptomatic Relief of a Patient with Recurrent Fibroids, Undergoing Laparoscopic Radiofrequency Fibroid Ablation

Abstract

Study Objective To document, through a case report video, a successful Laparoscopic Radiofrequency Ablation (Lap RFA) treatment for multiple recurrent fibroids after myomectomy. Design Video Case Report, 7 month follow up. Setting Hospital OR, Straight Stick Laparoscopy with Laparoscopic Ultrasound and Guidance Mapping. Patients or Participants 36-year-old African American, G0 with history of open myomectomy in 2010, presented with 2-year history of urinary frequency, urgency, constipation, back pain and heavy menstrual bleeding. Ultrasound imaging showed multiple fibroids including: 4.6 cm type 5, 5.4cm type 2, 2.4cm type 2, 3.0 cm type 2, and 2.1 cm type 2. The patient was seeking a uterine sparing alternative to a repeat myomectomy. Interventions Hysteroscopy, D&C, and Laparoscopic Radiofrequency Ablation, July 2019, with six fibroids treated, and 13 minutes of total ablation time. EBL 15cc. No surgical or postoperative complications. Measurements and Main Results 6 week post op visit: patient reports soreness, that her pelvis subjectively feels lighter, and spotting/discharge for 2 weeks that resolved by 1 month. 3 month follow up: ultrasound shows a 7.3 × 7.2cm vs previous 9 × 9cm uterus, multiple fibroids, 3.9cm (from 5.4cm), 2.2cm (from 3.0cm) and 3.9cm (from 4.6cm) in their largest dimensions. 6 month follow up: ultrasound shows a 9 × 6 × 5cm uterus and persistence in fibroid sizes. 7 month follow up: patient notes subjective improvement in urinary frequency, urgency, constipation, back pain and heavy menstrual bleeding. Conclusion Laparoscopic radiofrequency ablation resulted in decreased uterine and fibroid size and provided symptomatic relief in this patient and should be considered as a safe, minimally invasive alternative to repeat myomectomy in patients desiring uterine sparing treatment for recurrent fibroids and for those with complex, multi-fibroid uterine anatomy.