Transvaginal ultrasound-guided radiofrequency myolysis for uterine myomas

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Poognap-dong, Songpa-gu, Seoul 138-736, South Korea.
Human Reproduction (Impact Factor: 4.57). 03/2011; 26(3):559-63. DOI: 10.1093/humrep/deq366
Source: PubMed


Myolysis is one of the procedures that is claimed to provide significant improvement in myoma status without hysterectomy. Myolysis procedures have been generally performed via laparoscopy, and there are limited data on transvaginal radiofrequency (RF) myolysis. This study investigated the feasibility, efficacy and safety of transvaginal ultrasound-guided RF myolysis.
Transvaginal ultrasound-guided RF myolysis was performed on 69 premenopausal women with symptomatic uterine myomas as an outpatient procedure. Outcomes were assessed 1, 3, 6 and 12 months after RF myolysis. Myoma volumes were measured by ulrasonography. Menorrhagia was evaluated by the number of soaked normal-sized sanitary products used per menstrual period and overall symptoms were evaluated using the symptom severity subscale of the uterine fibroids symptom questionnaire.
Mean (± SD) age of patients was 39.8 ± 6.5 years. Mean baseline volume of the dominant myomas was 304.6 ± 229.1 cm(3) and its volume at 3 months following RF myolysis decreased compared with the previous examination (P = 0.002). An improvement of menorrhagia occurred 1, 3, 6 and 12 months after operation (all P < 0.001 versus baseline). Overall symptoms at 1, 3, 6 and 12 months after RF myolysis also improved (all P < 0.001 versus baseline). No major complications were observed or reported. After 12 months, three patients had successfully conceived and delivered and there were no complications during labor or delivery.
Transvaginal ultrasound-guided RF myolysis might be a safe, effective and minimally invasive outpatient procedure for uterine myoma in terms of size reduction, symptom improvement and safety.

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    • "Recently, Kim and colleagues have reported results of RF ablation in 69 women with fibroids up to 12.5 cm in diameter, some of who desired fertility [39]. They used a single RF needle electrode that was saline cooled, to prevent carbonization, and inserted it transvaginally under conscious sedation with transvaginal ultrasound guidance. "
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    ABSTRACT: The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.
    Obstetrics and Gynecology International 01/2012; 2012:194839. DOI:10.1155/2012/194839
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    ABSTRACT: Objectives To summarize the existing literature on therapeutic alternatives to hysterectomy and myomectomy for management of symptomatic uterine fibroids other than medicinal treatment and embolization. Patients and methods Pubmed, Cochrane and Embase contents were searched up to December 2010. Results The Nd:YAG laser appeared to be effective but equipment's cost and postoperative adherence risk limited its development. Bipolar, microwave and cryo-myolysis are still investigational. Radiofrequency thermal ablation is a less aggressive alternative when feasible under ultrasound guidance. Focused ultrasound surgery MR or ultrasound guided is accessible to approximately 10% of uterine fibroids with a rate of 60–70% of long-term symptom relief. Data following laparoscopic uterine artery occlusion suggest that outcomes are similar to those with uterine artery embolization (UAE) but with less long-term durability; by transvaginal way, there seem to be more complications. The efficiency of acupuncture remains uncertain. Conclusion Numerous technical innovations have been developed. However, comparative studies with validated conservative options are still needed.
    Fuel and Energy Abstracts 12/2011; 40(8). DOI:10.1016/j.jgyn.2011.09.029
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    ABSTRACT: Purpose of review: Many nonsurgical and minimally invasive therapies for symptomatic uterine fibroids have been introduced. The purpose of this review is to summarize the recent evidence on these techniques, and their effect on fibroid volume, menorrhagia, health related quality of life (HRQOL), fertility and their risk of complications. Recent findings: Laparoscopic or hysteroscopic myomectomy and uterine artery embolization (UAE) have been the most widely studied and all show significantly beneficial effects on menorrhagia and HRQOL, with a low incidence of complications. Magnetic resonance-guided high-intensity focused ultrasound (MRgFUS), myolysis/radiofrequency ablation (RFA) and laparoscopic or vaginal occlusion of uterine vessels (L/V-OUA) are newer interventions, with a smaller body of evidence.For women wishing to retain their childbearing possibilities, myomectomy is the best-studied intervention. Hysteroscopic myomectomy is specifically indicated in submucosal fibroids with subsequently beneficial effects on fertility. The use of UAE in fertile women has not been studied extensively, but evidence points toward an increase in adverse pregnancy outcomes after UAE compared with myomectomy. For MRgFUS, myolysis/RFA and L/V-OUA more evidence is needed. Summary: Laparoscopic/hysteroscopic myomectomy and UAE are evidence-based beneficial alternative therapies for symptomatic uterine fibroids. Until more evidence is available, myomectomy stays the option of choice for women who wish to conceive in the future.
    Current opinion in obstetrics & gynecology 09/2012; 24(6). DOI:10.1097/GCO.0b013e328359f10a · 2.07 Impact Factor
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