Radiofrequency Ablation Of Uterine Fibroids Research Articles

Radiofrequency Ablation of Uterine Fibroids – A New Gynecologic Treatment

While radiofrequency ablation (RFA) is accepted treatment for liver and bone cancer, its application in gynecology is relatively unknown. The purpose of this video is to introduce RFA and to demonstrate its utility in the treatment of symptomatic uterine fibroids. The basic science, instrumentation, and procedure are demonstrated. The procedure is outpatient, laparoscopic, and guided with intra-abdominal ultrasound. It involves placement of a needle electrode with deployable arms into the tumor and then using radiofrequency energy to produce coagulative necrosis. The treated tissue is reabsorbed and the surrounding myometrium remains intact. Tumors from <1 to 12 cm in diameter are treatable with this technique. Blood loss and serosal damage are negligible. Resolution of menorrhagia and dysmenorrhea occurs within 1–3 months. Uterine volume decreases 50–60%. Postoperative pain is minimal, return to work is within 7 days, and patient satisfaction is high. RFA is a viable gynecologic treatment for uterine fibroids.

Uterine Fibroid Ablation: The Beginning of the End of Uterine Fibroid Embolization?

The principles of uterine fibroid embolization have been extensively described in the literature [1–3]. In essence the technique involves the placement of a catheter into the uterine arteries followed by injection of embolization particles to obtain fibroid infarction and shrinkage. All the large prospective series and the first papers comparing embolization with hysterectomy in a randomized fashion now available in peer-reviewed journals confirm that embolization compares favorably with surgery [1–7]. These results published in both the radiological and gynecologic literature report similar results in terms of efficacy (80–90% for menorrhagia, pain, and bulk-related symptoms) and complications (1–4% major of complications) [1–7]. In this issue of Cardiovascular and Interventional Radiology, two groups of investigators report their initial experience on two alternative types of minimally invasive therapies to treat symptomatic fibroids [8, 9]. The first paper describe the use of laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroids in 4 patients and the second one the use of magnetic resonance-guided percutaneous cryoablation of uterine fibroids in 6 patients [8, 9].

Laparoscopic Ultrasound-Guided Radiofrequency Ablation of Uterine Fibroids

Four patients with symptomatic uterine fibroids measuring less than 6 cm underwent laparoscopic ultrasound-guided radiofrequency ablation (RFA) using multiprobe-array electrodes. Follow-up of the treated fibroids was performed with gadolinium-enhanced magnetic resonance imaging (MRI) and patients' symptoms were assessed by telephone interviews. The procedure was initially technically successful in 3 of the 4 patients and MRI studies at 1 month demonstrated complete fibroid ablation. Symptom improvement, including a decrease in menstrual bleeding and pain, was achieved in 2 patients at 3 months. At 7 months, 1 of these 2 patients experienced symptom worsening which correlated with recurrent fibroid on MRI. The third, initially technically successfully treated patient did not experience any symptom relief after the procedure and was ultimately diagnosed with adenomyosis. Our preliminary results suggest that RFA is a technically feasible treatment for symptomatic uterine fibroids in appropriately selected patients.

Radiofrequency ablation of uterine fibroids: Symptom relief and volume reduction at one year

Radiofrequency ablation of uterine fibroids: Symptom relief and volume reduction at one year