Laparoscopic Radiofrequency Ablation Research Articles

Radiofrequency Ablation of Uterine Fibroids and Pregnancy Outcomes: An Updated Review of the Literature

Study Objective The purpose of this article is to provide an updated review of pregnancy outcomes after laparoscopic and transcervical radiofrequency ablation of fibroids. Design Literature review using PubMed/Medline. Setting N/A. Patients or Participants Patients were identified from case reports and case series of pregnancies following trials of radiofrequency ablation (RFA) devices for symptomatic uterine fibroids. The pregnancies identified represented large trials of laparoscopic and transcervical ablation from North America, Asia, Europe, and Latin America. Interventions Laparoscopic and transcervical radiofrequency ablation of fibroids. Measurements and Main Results 6 publications met criteria for inclusion, representing 11 clinical trials and 3 reports from real-world settings. 593 patients underwent RFA of fibroids, with 46 total pregnancies identified. The average age of patients was 39 years old and ranged from 27 to 46 years old. The majority of patients had between one and three fibroids ablated, and the size varied from less than 2 centimeters up to 12.5 centimeters. In terms of pregnancy outcomes, among the 46 total pregnancies, there were 4 spontaneous abortions, 7 elective terminations of pregnancy, and 35 term pregnancies with 17 vaginal and 18 cesarean deliveries. The patients who experienced spontaneous abortion were 36 to 38 years old. There was one complication after cesarean delivery presenting as postpartum hemorrhage with resultant expulsion of degenerated myoma with no long-term sequelae. There were no cases of uterine rupture, uterine window, placenta accreta, placental abruption, or fetal growth restriction. Conclusion The majority of patients who had documented pregnancies after radiofrequency ablation of fibroids had full-term deliveries with no maternal or neonatal complications. Given the inherent obstetric risks with myomectomy (e.g., risk of uterine rupture, intrauterine scarring, possible need for cesarean delivery, etc.), these findings add to the growing consensus that radiofrequency fibroid ablation may offer a safe and effective minimally invasive treatment alternative to women seeking uterine-sparing fibroid treatment to preserve fertility. The purpose of this article is to provide an updated review of pregnancy outcomes after laparoscopic and transcervical radiofrequency ablation of fibroids. Literature review using PubMed/Medline. N/A. Patients were identified from case reports and case series of pregnancies following trials of radiofrequency ablation (RFA) devices for symptomatic uterine fibroids. The pregnancies identified represented large trials of laparoscopic and transcervical ablation from North America, Asia, Europe, and Latin America. Laparoscopic and transcervical radiofrequency ablation of fibroids. 6 publications met criteria for inclusion, representing 11 clinical trials and 3 reports from real-world settings. 593 patients underwent RFA of fibroids, with 46 total pregnancies identified. The average age of patients was 39 years old and ranged from 27 to 46 years old. The majority of patients had between one and three fibroids ablated, and the size varied from less than 2 centimeters up to 12.5 centimeters. In terms of pregnancy outcomes, among the 46 total pregnancies, there were 4 spontaneous abortions, 7 elective terminations of pregnancy, and 35 term pregnancies with 17 vaginal and 18 cesarean deliveries. The patients who experienced spontaneous abortion were 36 to 38 years old. There was one complication after cesarean delivery presenting as postpartum hemorrhage with resultant expulsion of degenerated myoma with no long-term sequelae. There were no cases of uterine rupture, uterine window, placenta accreta, placental abruption, or fetal growth restriction. The majority of patients who had documented pregnancies after radiofrequency ablation of fibroids had full-term deliveries with no maternal or neonatal complications. Given the inherent obstetric risks with myomectomy (e.g., risk of uterine rupture, intrauterine scarring, possible need for cesarean delivery, etc.), these findings add to the growing consensus that radiofrequency fibroid ablation may offer a safe and effective minimally invasive treatment alternative to women seeking uterine-sparing fibroid treatment to preserve fertility.

Systematic Review of Outcomes after Radiofrequency Ablation for Fibroids: An Aagl Practice Committee Evidence Review

Study Objective To review the existing literature regarding short- and long-term outcomes after radiofrequency (RF) fibroid ablation. Design Systematic review. Setting N/A. Patients or Participants All studies that are comparative were included, and non-comparative studies with at least 10 participants per group, in any language, in any country/setting were included. Interventions We conducted a systematic review or all studies examining the use of RF ablation for the treatment of fibroids which reported clinical and patient-centered outcomes and complications. We searched existing systematic reviews and Medline, Embase, and Cochrane from inception through February 2, 2021. We included comparative and noncomparative studies of RF ablation and RF ablation compared to other interventions. Measurements and Main Results 7260 abstracts were doubly reviewed by members of the AAGL Practice Committee. Of these, 29 studies met inclusion criteria. 11 studies examined laparoscopic ultrasound guided RF ablation. 2 studies examined laparoscopic RF ablation (without imaging guidance). 5 studies examined percutaneous ultrasound guided RF ablation, 1 study examined percutaneous CT guided RF ablation, 6 studies examined transvaginal ultrasound guided RF ablation. 4 studies examined transcervical ultrasound guided RF ablation. Conclusion Worldwide, various types of radiofrequency fibroid ablation procedures are being performed for the treatment of symptomatic fibroids, including laparoscopic, percutaneous, transcervical and transvaginal routes, either with or without image guidance. Review of the available literature demonstrates that these procedures are associated with rare major complications and reintervention rates are low. Fibroid volume, bleeding, pain, bulk symptoms and overall quality of life improve after RF ablation. To review the existing literature regarding short- and long-term outcomes after radiofrequency (RF) fibroid ablation. Systematic review. N/A. All studies that are comparative were included, and non-comparative studies with at least 10 participants per group, in any language, in any country/setting were included. We conducted a systematic review or all studies examining the use of RF ablation for the treatment of fibroids which reported clinical and patient-centered outcomes and complications. We searched existing systematic reviews and Medline, Embase, and Cochrane from inception through February 2, 2021. We included comparative and noncomparative studies of RF ablation and RF ablation compared to other interventions. 7260 abstracts were doubly reviewed by members of the AAGL Practice Committee. Of these, 29 studies met inclusion criteria. 11 studies examined laparoscopic ultrasound guided RF ablation. 2 studies examined laparoscopic RF ablation (without imaging guidance). 5 studies examined percutaneous ultrasound guided RF ablation, 1 study examined percutaneous CT guided RF ablation, 6 studies examined transvaginal ultrasound guided RF ablation. 4 studies examined transcervical ultrasound guided RF ablation. Worldwide, various types of radiofrequency fibroid ablation procedures are being performed for the treatment of symptomatic fibroids, including laparoscopic, percutaneous, transcervical and transvaginal routes, either with or without image guidance. Review of the available literature demonstrates that these procedures are associated with rare major complications and reintervention rates are low. Fibroid volume, bleeding, pain, bulk symptoms and overall quality of life improve after RF ablation.

Treatment of a special-located occult hepatic cancer in a cirrhotic patient using laparoscopic ultrasound-guided radiofrequency ablation: a case description.

Treatment of a special-located occult hepatic cancer in a cirrhotic patient using laparoscopic ultrasound-guided radiofrequency ablation: a case description.

PMD2 Laparoscopic Radiofrequency Ablation VS Laparoscopic Myomectomy in the Treatment of Symptomatic Uterine Leiomyomas: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviews the evidence from randomized controlled trials (RCTs) which compare laparoscopic radiofrequency ablation (LAP-RFA) and laparoscopic myomectomy (LM), two uterine sparing procedures for managing symptomatic uterine leiomyomas (UL).

Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension.

The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic advantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients’ preoperative liver function should be adequately estimated.

Laparoscopic adrenalectomy vs. radiofrequency ablation for the treatment of primary aldosteronism. A single center retrospective cohort analysis adjusted with propensity score.

Laparoscopic adrenalectomy (LA) is the gold standard treatment for unilateral primary aldosteronism. However, satisfactory results have also been published with radiofrequency ablation (RFA). The aim of this study was to compare LA and RFA for the treatment of primary aldosteronism. A retrospective cohort study of the patients who underwent LA or RFA in a single center was performed. Morbidity and long-term effectiveness (cure rate and blood pressure control) were analyzed. A multivariate analysis with a propensity score was also performed. Thirty-four patients were included in the study, 24 in the LA group and 10 in the RFA group. Hypertension had been diagnosed a median of 12years before the intervention. Hypertension was properly controlled before the intervention in 55.9% of the patients. Hypertensive crisis was more common during RFA (4.2% vs. 70.0%, p < 0.001), although no patient suffered any complication because of these crises. LA was longer (174.6 vs. 105.5min, p = 0.001) and had a longer length of stay (median 2 vs 1days, p < 0.001). No severe complications were observed in any of the patients. After a median follow-up of 46.2months, more patients had hypertension cured and blood pressure controlled in the LA group (29.2% vs. 0%, p = 0.078 and 95.5% vs. 50.0%, p = 0.006, respectively). Also, patients in the LA group were taking less antihypertensive drugs (1.8 vs. 3.0, p = 0.054) or mineralocorticoid receptor antagonists (41.7% vs. 90.0%, p = 0.020). Multivariate analysis adjusted by propensity score showed that LA had an OR = 11.3 (p = 0.138) for hypertension cure and an OR = 55.1 (p = 0.040) for blood pressure control. Although RFA was a less invasive procedure than LA, hypertension was cured and blood pressure was properly controlled in more patients from the LA group. Patients who underwent LA were taking less antihypertensive drugs than patients who had undergone RFA.

Laparoscopic radiofrequency ablation of subcapsular hepatocellular carcinomas: risk factors related to a technical failure.

This study aimed to evaluate the risk factors related to a technical failure after laparoscopic radiofrequency ablation (RFA) for subcapsular hepatocellular carcinomas (HCCs). A total of 110 patients with 114 HCCs who underwent laparoscopic RFA for HCCs (new HCC [n = 85] and local tumor progression [LTP] [n = 29]) between January 2013 and December 2018 were included. We evaluated the incidence of technical failure on immediate post-RFA CT images. Risk factors for a technical failure after laparoscopic RFA were assessed using univariable logistic regression analyses. The cumulative LTP rate was estimated using the Kaplan-Meier method. Technical failure was noted in 3.5% (4/114) of the tumors. All four tumors that showed a technical failure were cases of LTP from previous treatment and were invisible on laparoscopy. On univariate analysis, LTP lesion, invisibility of the index tumor on laparoscopy, and peri-hepatic vein location of the tumor were identified as risk factors for a technical failure. The cumulative LTP rates at 1, 3, and 5years were estimated to be 2.8%, 4.8%, and 4.8%, respectively. LTP lesion, invisibility of the index tumor on laparoscopy, and peri-hepatic vein location of the tumor were identified as the risk factors for a technical failure after laparoscopic RFA.

Simultaneous laparoscopic liver resection or radiofrequency ablation by single-port approach during elective loop-ileostomy closure: A novel strategy in patients with colorectal metastases

BackgroundTo report on the feasibility, the morbidity and the mortality of a novel strategy for patients undergoing loop-ileostomy closure for colorectal cancer with synchronous treatment of colorectal cancer liver metastases (CRCLM). MethodsThe strategy consisted of laparoscopic liver resection (LLR) or radiofrequency ablation (LRFA) of CRCLM by a single-port approach and a simultaneous elective loop-ileostomy closure. All consecutive patients who underwent this strategy were included. Short-term and middle-term results and the patient’s perioperative satisfaction were recorded. ResultsBetween 2017 and 2019, five patients with CRCLM were treated according to this strategy. The feasibility was 100 %. The overall morbidity was 20 % (n=1, postoperative ileus) and the mortality was 0 %. The CRCLM were treated by wedge resection (n=3) or LRFA (n=3). The mean blood loss was 70±116.6mL [300-50]. The mean operating time was 168±52.3 [100–220] minutes. The mean LOS was 3.5±1.4 days [2–5]. The average EVAN G score was 83.3 % [70–95] showing a global satisfaction of the patients on the perioperative course. The rate of R0 resection was 80 % and the rate of local recurrence was 20 %. The 2-years overall survival rate was 84 % (n=4). At the end of follow-up, the rate of incisional hernia was 0 %. ConclusionsThis mini-invasive approach appears to be feasible, safe and useful for patients.

Efficacy and safety of radiofrequency ablation versus laparoscopic hepatectomy for small hepatocellular carcinoma: A protocol for a randomized controlled trial.

Background:Hepatocellular carcinoma (HCC) is one of the most common type of malignant tumors in adults, and is the most common cause of death in people with cirrhosis. Both laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) are radical treatments for small HCC. However, there is no international standard for the treatment of small HCC, and it is still controversial to choose LH or RFA in treating small HCC. We try to carry out a randomized, controlled, prospective study to compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC.Methods:This study is a single-center, evaluator-blinded, randomized, controlled clinical trial (RCT). The patients will be randomly divided into RFA group and LH group in a 1:1 ratio according to a computer-generated randomization list. Postoperative complications rates, Alpha fetoprotein (AFP), hospital stay, 1, 2, 3-year overall survival (OS) rates, disease-free survival (DFS) rates and all possible adverse events will be recorded. Statistical analyses will be performed with SPSS v22.0 software.Conclusions:The study will compare the the short-term and long-term effects and safety of LH versus RFA in the treatment of small HCC.OSF Registration number:doi: 10.17605/OSF.IO/HNX2T

Transcatheter chemoembolization plus percutaneous radiofrequency ablation versus laparoscopic radiofrequency ablation: improved outcome for inoperable hepatocellular carcinoma

Aims To retrospectively compare the efficacy of transcatheter chemoembolization (TACE) plus percutaneous radiofrequency ablation (PRFA) (hereafter, TACE + PRFA) and laparoscopic radiofrequency ablation (LRFA) in the treatment of inoperable hepatocellular carcinoma (HCC). Methods From July 2014 to December 2017, 132 consecutive patients with inoperable HCC were treated with TACE + PRFA (n = 86) or LRFA (n = 46). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using log-rank test and Cox regression analysis. Propensity score matched (PSM) analyses based on patient and tumor characteristics were also conducted. Additionally, we performed exploratory analyses to determine the effectiveness of TACE + PRFA and LRFA in clinically relevant subsets. Results The baseline characteristics of TACE + PRFA patients displayed relatively inferior liver status and a higher rate of BCLC-B disease. For unmatched patients, median OS (55.0 vs. 42.0 months; p = .019) and RFS (20.0 vs. 11.0 months; p < .001) were significantly longer in TACE + PRFA group than that in the LRFA group. After PSM, 39 matched pairs were identified. The difference in median OS (60.0 vs. 44.0 months; p = .009) and RFS (27.0 vs. 11.0 months; p < .001) between the two groups remained significant. Multivariate analysis in matched patients showed that treatment modality and response to initial treatment were significant predictors of OS and RFS, while recurrence after resection was an independent prognostic factor of OS. The benefits of TACE + PRFA were consistent across all the subgroups examined. The different treatments had shared a similar complication rate. Conclusions Compared to LRFA, TACE + PRFA results in improved OS and RFS in patients not amenable to resection.

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

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.

Concomitant Use of Laparoscopic Radiofrequency Ablation with Hysteroscopic Myomectomy for Large, Multi-Fibroid Uterus

Study Objective To discuss the combination of minimally invasive myomectomy techniques for large multi-fibroid uteri to ensure resolution of all associated symptoms. Design Case Study. Setting Suburban hospital, Michigan. Patients or Participants 37-year-old Caucasian G2P1011. Interventions 1. Hysteroscopic resectoscope of submucosal fibroid (TruClear) 2. Ultrasound guided laparoscopic radiofrequency ablation (Acessa system) of intramural, subserosal, and broad ligament fibroids Measurements and Main Results Patient presented with a longstanding history of a bulky, multi-fibroid uterus. Her symptoms included menorrhagia (resulting in anemia), lower abdominal pressure, cramping and back pain. Two prior gynecologists had recommended open hysterectomy given that she had completed childbearing, however she desired uterine conserving surgery. Physical exam revealed a BMI of 24 and a 20-week multi-fibroid uterus. Previous ultrasound noted a multi-fibroid uterus measuring 19 × 14.1 × 8.3 cm and pre-operative MRI demonstrated the largest intramural fibroid to measure 10.9 × 9.1 × 9.2 cm in the posterior lower uterine segment. A pedunculated submucosal (type 0) fibroid was also identified with significant distortion of the endometrial cavity. She elected to proceed with laparoscopic radiofrequency ablation with ultrasound guidance for the type 4-8 fibroids with concurrent mechanical resection of her submucous fibroid. The procedure was performed without complication and the total operative time was less than 2.5 hours. She was discharged from recovery in good condition. At 6-month follow-up, she noted significant reduction in pain, pressure and cramping, with almost complete resolution of menorrhagia. Conclusion Uterine sparing concomitant multi-modality surgery can be considered for patients presenting with large fibroids, including those with submucosal fibroids as a cause for their symptoms. Laparoscopic radiofrequency ablation combined with hysteroscopic resection, even for fibroids larger than 8 cm, can provide dramatic relief of menorrhagia, bulk and pain symptoms.

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

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.

Ultrasound Guided Laparoscopic Radiofrequency Ablation for Very Large Multi-Fibroid Uterus

Study Objective This video describes the technique and advantages of laparoscopic radiofrequency ablation with ultrasound guidance for the treatment of very large multi-fibroid uteri. Design N/A Setting Large tertiary care hospital. Patients or Participants 45-year-old gravida 2 para 0 female with menorrhagia, dysmenorrhea, and bulk symptoms secondary to a very large multi-fibroid uterus. She desired a minimally invasive and uterine conserving method to treat her symptoms. Interventions We performed laparoscopic radiofrequency ablation under ultrasound guidance for the patients’ multiple fibroids. The uterus was mapped ultrasonographically using the laparoscopic ultrasound transducer. Next, under laparoscopic visualization, the needle handpiece was inserted into the abdomen three centimeters away from the ultrasound transducer insertion point. With careful coordination between visualization on the ultrasound and the laparoscope, the handpiece was directed into specific myomas for ablation with deployment of the needle arrays. This allowed emission of radiofrequency energy to shrink the myoma tissue. The exact depth and total ablation time is calculated for each deployment prior to initiation of the ablation. It is important to note that larger myomas may require multiple overlapping treatments due to their size and density. The procedure was performed in an outpatient setting with an estimated blood loss of less than 10 milliliters. Measurements and Main Results N/A Conclusion Laparoscopic radiofrequency ablation for very large multi-fibroid uteri can be successfully performed under ultrasound guidance as a uterine conserving method to treat symptomatic fibroids. The technique has many advantages when compared to other surgical techniques used to treat fibroids, including minimal blood loss, decreased post-operative pain, shorter recovery time, and a potentially narrower learning curve given that advanced laparoscopic suturing skills are not required.

Radiofrequency Ablation of an 11cm Posterior Transmural Fibroid

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.

The Long-Term Efficacy of Radiofrequency Ablation Versus Laparoscopic Hepatectomy for Small Hepatocellular Carcinoma in East Asia: A Systematic Review and Meta-Analysis

Context: Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term efficacy of RFA compared with LH for small HCC (sHCC) patients in the East Asian population. Evidence Acquisition: We performed a systematic review and meta-analysis by the literature search on PubMed, Cochrane Library, EMBASE, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang from their inception until October 10, 2019, for comparing the long-term efficacy outcomes of RFA with LH. Results: Fourteen retrospective studies with 1,390 subjects were included in the meta-analysis. Compared with the LH-treated group, RFA could raise the local recurrence rate under median follow-up duration and reduce disease-free survival (DFS) rates at 1 - 3 years. However, it failed to affect 5-year overall survival (OS) and DFS rates. In the subgroup analyses, different RFA approaches had significantly higher local recurrence rates than the LH group. A similar effect on OS and DFS rates within five years for single early (≤ 3 cm) HCCs and on the 1- and 5-year DFS rates for nodules ≤ 5 cm were observed between the two groups, but RFA approaches could reduce the 3-y OS and DFS rates for single nodules ≤ 5 cm. The percutaneous radiofrequency ablation (PRFA) group had significantly lower 3- and 5-year OS and the 1- and 3-year DFS rates than the LH group, while no significant difference in OS and DFS rates in the laparoscopic radiofrequency ablation (LRFA) approach. The RFA approach improved the 3-year OS compared with the LH group in Japan, but reduced the 3-year OS and DFS rates within 3 years in China. Conclusions: Our results support that LH treating sHCC had a better long-term efficacy and a lower local recurrence rate than RFA in the East Asian population. Further high-quality prospective studies are required to confirm the long-term efficacy.

Early experience with laparoscopic treatment of liver tumors using a separable cluster electrode with a no-touch technique.

IntroductionRadiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Laparoscopic RFA has the benefit of direct visual control of the RFA procedure. Cluster electrodes (Octopus RF electrodes) can create a common ablation zone.AimUsing these two methods (laparoscopic approach and no touch technique), this present study evaluated the technical and clinical outcomes of early experience with laparoscopic RFA and a no-touch technique.Material and methodsBetween November 2015 and November 2018, 21 patients underwent laparoscopic RFA for hepatocellular carcinoma with a no-touch technique using cluster electrodes. Laparoscopic RFA is recommended for patients with a contraindication for surgical resection, patients wants and a relative contraindication for conventional percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct, or heart.ResultsIn the 21 tumors, 2 were treated with a single electrode, 12 with 2 electrodes, and 7 tumors with 3 electrodes. The mean time of ablation per lesion was 20.43 ±8.77 min. There was no mortality, local tumor progression, delayed destructive biliary damage, or liver abscess at the follow-up computed tomography. No technical failures occurred.ConclusionsLaparoscopic RFA can access lesions for which percutaneous RFA is contraindicated or risky. Cluster electrodes can create sufficient ablation zones without contact and can achieve a sufficient margin with a low complication rate and no tumor dissemination. Therefore, laparoscopic RFA with a no-touch technique might be a safe and feasible treatment for HCC tumor in selected patients.

Treatment of Insulinomas by Laparoscopic Radiofrequency Ablation: Case Reports and Literature Review.

Despite its rarity, insulinoma is the most common type of pancreatic endocrine neoplasm, with an occurrence of 1 to 5 per million per year in the population. Surgical resection or enucleation is the first line of curative treatment choice for insulinoma. Eight patients with symptomatic insulinomas treated by radiofrequency ablation have been described since 2009. In the past two years, we treated two patients with symptomatic insulinomas (one in the pancreatic tail and the other in the pancreatic neck) successfully using laparoscopic radiofrequency ablation. Both patients achieved complete elimination without any significant complications. Our study suggests laparoscopic radiofrequency ablation could be developed as a safe and effective alternative treatment to surgery for the patients with insulinomas who refuse or are not eligible for surgery.

Post-Market Safety of Laparoscopic Ultrasound-Guided Radiofrequency Ablation.

Background and Objectives:Postoperative safety outcomes with laparoscopic intra-abdominal ultrasound-guided radiofrequency ablation, as performed by gynecologic surgeons new to the procedure, were evaluated and compared to the premarket, pivotal study. Post-procedure feedback from surgeons was reported.Methods:This was a post-market, prospective, single-arm analysis with 4 to 8 weeks follow-up among surgeons (n = 29) with varying levels of laparoscopic surgery experience participating in the ongoing, multinational Treatment Results of Uterine Sparing Technologies randomized clinical trial. Patients were premenopausal adult women (n = 110) desiring uterine-conserving treatment for symptomatic fibroids. During run-in, surgeons received proctored training. Following training, and after performing ≥ 2 procedures, surgeons provided self-assessment and feedback using a standardized form.Results:Surgeons performed 105 procedures with 100 per-protocol patients. The average number of proctored cases per surgeon was 2.48. No acute (≤ 48 hours) serious adverse events occurred (0/101, 0.0%) compared with 2 acute serious adverse events in the premarket study (2/137, 1.46%). Both studies reported 1 near-term (∼30 days) serious adverse event (< 1% for both). In this study, the near-term complication was fever of unknown origin requiring hospitalization related to uterine entry/manipulation. This was categorized as probably device-related; the patient was treated with antibiotics and discharged. Twenty-six surgeons completed the evaluation form; none reported experiencing problems with the procedure.Conclusion:Minimally invasive gynecologic surgeons can learn laparoscopic intraabdominal ultrasound-guided radiofrequency ablation and perform it safely (in terms of acute and near-term serious adverse events) after ≥ 2 proctored cases. There were no significant differences in safety outcomes compared to the premarket, pivotal study.

Laparoscopic radiofrequency ablation (RFA) of liver tumors

The prevalence of patients with hepatic malignant tumors is rising and thus treatment strategies to specifically treat hepatic tumors continue to evolve. Local-regional treatment to the liver utilizing surgical resection continues to have the greatest efficacy in patients who are candidates. Therefore, thermal ablation of hepatic tumors in patients who are not candidates for resection remains a cornerstone of local-regional treatment for both primary liver cancers and metastatic tumors to the liver. While ablation is second in efficacy to surgical hepatic resection, ablation can aim toward curative intent in many circumstances when properly deployed. Thus, thermal or heat ablation using either radiofrequency ablation or microwave ablation, are part of the standard of care armamentarium for which hepatobiliary surgeons should be skilled at performing. Ablation can be performed with minimal invasiveness and is most commonly performed percutaneously using radiographic guidance. However, surgical ablation is still occasionally required and can thus be pursued utilizing laparoscopy in these clinical scenarios. This review will summarize the indications, benefits, and potential pitfalls for laparoscopic ablation of liver tumors.