Radiofrequency Thermal Ablation of Submucosal Leiomyoma: A Preliminary Report on Health, Symptom, and Quality of Life Outcomes

Abstract

Objectives: Submucosal leiomyoma commonly causes abnormal uterine bleeding, menstrual abnormalities, and infertility, and is usually treated by hysteroscopy. However, not all submucosal leiomyomas can be treated by hysteroscopy; patients with high-scoring submucosal leiomyoma must undergo transabdominal myomectomy to preserve the uterus. This article reports experience with a group of patients who underwent transvaginal radiofrequency (RF) thermal ablation of uterine submucosal leiomyomas of all grades, with emphasis on the safety and efficacy of this procedure. Study design: This was a prospective observational study. Materials and methods: Premenopausal women with symptomatic uterine submucosal leiomyoma were included in this study. The preand postoperative myoma volumes were measured by three-dimensional ultrasonography. The effect of symptoms on health-related quality of life (HRQoL) was assessed using the Uterine Fibroids Symptom and Quality of Life questionnaire. Results: Submucosal leiomyoma volume reduction rate was 75.5 AE 14.1% at 3 months and 80.7 AE 22.1% at 6 months postoperation. No differences were seen in the volume reduction rate according to the preoperative grade of leiomyoma. Symptom scores and HRQoL scores showed improvements 18 months after surgery with no differences between grades. Penetration=burn injuries of the bowel or bladder, sepsis, shock, embolism, and peritonitis were not reported. Conclusions: Transvaginal RF thermal ablation is a good treatment method for symptomatic submucosal leiomyoma, especially for patients with a high leiomyoma grade and when there is no choice for treatment except hysterectomy or hysterotomy. ( J GYNECOL SURG 26:227)

Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies

“…Lim et al 5 reported that laparoscopic Bongers et al 15 39 -23 -4.4 -3.1 -Brölmann et al 16 Garza-Leal 17 ----Braun et al 18 114 -60 6.8 -3.2 --Brucker et al 19 66 -24 10.0 -5.5 20.5 (5, 103) a 10.0 (2, 86) a Hahn et al 20 Krämer et al 21 Carrafiello et al 22 20 (15, 25) b ---Cho et al 23 -(10, 40) ---Cho et al 24 ----Chudnoff et al 25 126 -60 -9.0 (2, 60) a 5.0 (0, 29) a Galen et al 26 Guido et al 27 Berman et al 28 Chudnoff et al 29 47 -30 2. 30 Galen et al 31 140 (42, 290) a -4.5 (1, 11) b 4.0 (2, 10) a Garza-Leal et al 32 Robles et al 33 Ghezzi et al 34 25 (20, 45) a 18 c --Bergamini et al 35 Iversen and Dueholm 36 ----Iversen et al 37 Jiang et al 38 25 (20, 30) b ---Kim et al 39 18 -5 ---Lee et al 40 ----Marcos et al 41 36 -11 12.0 (8, 24) b --Meng et al 42 ----Rattray et al 43 73 -26 6.7 -3.0 -11.1 -7.6 Rey et al 44 17 (11, 44) b ---Turtulici et al 45 28 (16, 43) b ---Wu et al 46 -(20, 40) 2.5 c --…”

Effectiveness of a Hysteroscopic Tissue Removal System Device for Hysteroscopic Myomectomy on Patients’ Quality of Life: A Randomized Clinical Trial

“…Studies have shown that quality of life after hysteroscopic myomectomy was signi cantly better than after laparoscopic myomectomy due to shorter operative duration, less intraoperative bleeding, and shorter hospitalization [18]. Other uterine sparing minimally invasive techniques available for treating submucosal broids include uterine artery embolization (UAE) [19], hysteroscopic myomectomy after UAE [20], and transvaginal radio-frequency myolysis [21,22] and magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) [23,24]. UAE showed improvement in symptom score and quality of life score outcomes when associated with heavy bleeding and submucosal leiomyoma location [25].…”

“…22 patients dropped out of the study. The same number of patients (N = 11) dropped out from the surgical arm, like the number of patients who dropped out of the medication treatment arm (N = 11).…”