Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice

Abstract

Among gynecologists with no prior training, the initial cases of laparoscopic radiofrequency ablation of leiomyomas can be performed with rapid onset of surgical confidence and favorable clinical outcomes. ABSTRACT Study ObjectiveTo assess surgical outcomes, clinical effectiveness, and gynecologist's experience of introducing laparoscopic radiofrequency ablation (RFA) of leiomyomas into surgical practice. Design Uncontrolled clinical trialSetting 5 academic medical centers across California PatientsPremenopausal women with symptomatic uterine leiomyomas, uterus ≤16 week size and all leiomyomas ≤10 cm with no more than 6 total leiomyomas. InterventionsLaparoscopic RFA of leiomyomas. Measurements and Main ResultsWe assessed intraoperative complications, blood loss, operative time, and adverse events. Gynecologists reported the difficulty and need for further training after each case. Participants reported leiomyoma symptoms preoperatively and at 6 and 12 weeks after surgery. We analyzed all outcome data from the first case performed by gynecologists with no prior RFA experience. 157

Recurrent leiomyomatosis peritonealis disseminata

“…studies are limited to patients with fewer than six leiomyomas and lesions <10 cm. 7 An important factor to consider in this case is the risk of recurrence of leiomyomas in relation to the surgical approach chosen for myomectomy. Despite the fact that no differences have been found in the recurrence rate when comparing the open and laparoscopic Tumor board techniques, when ≤5 leiomyomas are resected, the recurrence rate is higher with the minimally invasive approach for >5 leiomyomas.…”

“…However, due to safety concerns of morcellation in relation to the recurrence or potential spread of inadvertent malignant lesions, large lesions represent a challenge for this approach. A laparoscopic radiofrequency ablation technique has recently emerged, but published studies are limited to patients with fewer than six leiomyomas and lesions <10 cm 7…”

Therapeutic options for the management of abnormal uterine bleeding

“…Transcervical ultrasound‐guided RFA with the Sonata system has significantly improved menstrual blood loss for up to 2 years after the procedure 108 . Laparoscopic and simultaneous laparoscopic ultrasound‐directed RFA has undergone relatively extensive studies showing enduring HMB results at 3 years, 109 and evidence that the approach may be readily adapted to practice 110 . Magnetic resonance‐guided focused ultrasound (MRgFUS) has been associated with short‐term efficacy; however, long‐term outcomes, including the effect on fertility, remain unclear 111 .…”

Regarding “Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice”

“…Jacoby et al [2] now present the safety and efficacy of laparoscopic radiofrequency ablation. Br€ olman et al [3] as well as our own working group have already published similar results in transcervical ultrasound-guided radiofrequency therapy [4].…”