Transcervical fibroid ablation with the Sonata™ system for treatment of submucous and large uterine fibroids

Shifrin, G.; Engelhardt, Matthias; Gee, P.; Pschadka, Gregor

doi:10.1002/ijgo.13638

“…Besides myomectomy and hysterectomy (via laparotomy or endoscopic approach), a broad spectrum of options is available for the treatment of myomas, including pharmacological myoma growth control (GnRH analog, ulipristal) and nonsurgical procedures (artery embolization, radiofrequency ablation, sonography-guided transcervical fibroid ablation, high-intensity focused ultrasound ablation). The election should be based on risk-benefit analysis, depending on the patient's desire, size, number, and location of the fibroids and the requirement of a multistage approach to obtain a reduction in the fibroid or its related symptoms [23]. The endoscopic management of large and giant uterine myomata, which are not frequently described [24], requires the use of morcellation for surgical specimen retrieval.…”

Section: Discussionmentioning

confidence: 99%

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Devassy

¹

,

Devassy

²

,

Wilde

³

et al. 2023

JCM

1

0

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Contained electromechanical morcellation has emerged as a safety approach for laparoscopic myomatous tissue retrieval. This retrospective single-center analysis evaluated the bag deployment practicability and safety of electromechanical in-bag morcellation when used for big surgical benign specimens. The main age of patients was 39.3 years (range 21 to 71); 804 myomectomies, 242 supracervical hysterectomies, 73 total hysterectomies, and 1 retroperitoneal tumor extirpation were performed. A total of 78.7% of specimens weighed more than 250 g (n = 881) and 9% more than 1000 g. The largest specimens, weighing 2933 g, 3183 g, and 4780 g, required two bags for complete morcellation. Neither difficulties nor complications related to bag manipulation were recorded. Small bag puncture was detected in two cases, but peritoneal washing cytology was free of debris. One retroperitoneal angioleiomyomatosis and three malignancies were detected in histology (leiomyosarcoma = 2; sarcoma = 1); therefore, patients underwent radical surgery. All patients were disease-free at 3 years follow-up, but one patient presented multiple abdominal metastases of the leiomyosarcoma in the third year; she refused subsequent surgery and was lost from follow-up. This large series demonstrates that laparoscopic bag morcellation is a safe and comfortable method to remove large and giant uterine tumors. Bag manipulation takes only a few minutes, and perforations rarely occur and are easy to detect intraoperatively. This technique did not result in the spread of debris during myoma surgery, potentially avoiding the additional risk of parasitic fibroma or peritoneal sarcoma.

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“…Comprehensive rehabilitation nursing is a comprehensive nursing intervention model, involving medication, diet, exercise, psychology and other aspects of patients [ 16 ]. This study found that the postoperative exhaust time, ambulation time, postoperative hospitalization time and total hospitalization time of the comprehensive rehabilitation nursing intervention group were shorter than those of the routine nursing intervention group, and the hospitalization expenses were less than those of the routine nursing intervention group.…”

Section: Discussionmentioning

confidence: 99%

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Liu¹,

Gao²,

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim. This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods. The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results. The postoperative exhaust time ( 13.14 ± 2.03 ) h, bed time ( 9.86 ± 1.94 ) h, postoperative hospital stay ( 4.37 ± 1.31 ) d, and total hospital stay ( 6.78 ± 1.69 ) d in the B group were shorter than those in the A group, and the hospitalization expenses ( 0.74 ± 0.25 ) million were less than those in the A group ( P < 0.05 ). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups ( P > 0.05 ). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1β (IL-1β) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group ( P < 0.05 ). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group ( P < 0.05 ). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention ( P > 0.05 ). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group ( P < 0.05 ). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group ( P < 0.05 ). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant ( P > 0.05 ). Conclusion. Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.

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“…The pivotal SONATA study showed a 62.4% mean maximal fibroid volume reduction per patient [22,25]. Recent subgroup analyses of >5 cm and separately submucosal fibroids in the FAST-EU showed similar fibroid reduction [27]. A recent systematic review of ten articles on TFA reports consistent results including 63.2% mean fibroid volume reduction at 12 months [26 && ].…”

Section: Transcervical Radiofrequency Ablationmentioning

confidence: 95%

Radiofrequency ablation methods for uterine sparing fibroid treatment

Baxter

¹

,

Seaman

²

,

Arora

³

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThis article provides a clinical review of radiofrequency ablation (RFA) for the treatment of uterine leiomyomas. Recent findingsRFA is an effective and durable treatment for fibroids with sustained improvements in fibroid volume, bleeding, and patient reported outcomes with low reintervention rates. Although fertility data is limited, it is overall positive and may represent a uterine conserving and fertility preserving treatment modality. SummaryRFA is a safe and effective uterine preserving treatment option for symptomatic leiomyomas.

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Transcervical fibroid ablation with the Sonata™ system for treatment of submucous and large uterine fibroids

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 9 publications

References 29 publications

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Radiofrequency ablation methods for uterine sparing fibroid treatment

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