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: Myolysis and leiomyomas Moradan S. MD* Introduction & Objective: Leiomyomas are benign smooth muscle neoplasms which typically originate from myometrium. The incidence among women of reproductive age group is 20 to 25 percent. Most of the leiomyomas are asymptomatic but the symptomatic cases present with bleeding, pain and infertility. There are medical and surgical treatments for leiomyomas such as GnRh agonists, myomectomy, hysterectomy, uterine artery embolization and myolysis. Regarding the possibility of utrine and fertility saving, we discusse cons and pros of myolysis versus other technics in this article. Key Words: Leiomyoma, myolysis. *Associate
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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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