1
|
Niddam R, Netter A, Courbière B, Agostini A, Miquel L. Laparoscopic Multibipolar Radiofrequency Myolysis for Symptomatic Myomas in 10 Steps. J Minim Invasive Gynecol 2024; 31:475-476. [PMID: 38493828 DOI: 10.1016/j.jmig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE To describe a minimal invasive 10-step technique of laparoscopic multibipolar radiofrequency myolysis for symptomatic myomas. DESIGN A step-by-step video demonstration of the technique. SETTING A woman with symptomatic FIGO 5 myoma of 60 mm of diameter, confirmed by magnetic resonance imaging. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. INTERVENTIONS Approximately 30% of women of child-bearing age with myomas will present with symptoms [1] that include chronic pelvic pain, abnormal uterine bleeding or infertility [2,3]. Data regarding fertility preservation and obstetric outcomes suggest that radiofrequency myoma ablation may offer an alternative to existing treatments for women who desire future fertility [4]. The local institutional review board stated that approval was not required because the video describes a technique and not a clinical case. In our center, all radiofrequency indications are discussed during a monthly multidisciplinary myomas meeting. This video presents the procedure divided into the following 10 steps: planning of the surgery; materials; installation; laparoscopic exploration; transvaginal ultrasound examination; visual and transvaginal ultrasound guided transparietal puncture of the myoma; control of the applicators' position; radiofrequency myolysis; end of myolysis, applicators removal; final check and additional procedures. CONCLUSION Radiofrequency myolysis is a simple and reproductible procedure that can be offered as an alternative to myomectomy [5]. This video presents 10 steps to make the procedure easier to adopt and to reduce its learning curve.
Collapse
Affiliation(s)
- Raphael Niddam
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France.
| | - Antoine Netter
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Blandine Courbière
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France; Department of Biomarkers, Environment and Health (Dr. Courbière), Aix Marseille University, CNRS, IRD, Avignon University, IMBE, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Laura Miquel
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| |
Collapse
|
2
|
Hansen-Lindner L, Schmid-Lossberg J, Toub D. Transcervical Fibroid Ablation (TFA): Update on Pregnancy Outcomes. J Clin Med 2024; 13:2892. [PMID: 38792434 PMCID: PMC11122290 DOI: 10.3390/jcm13102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Transcervical fibroid ablation (TFA) is an incisionless method to treat symptomatic uterine fibroids. While safety regarding future pregnancy remains to be established, TFA does not preclude the possibility of pregnancy, and a previous 36-patient case series of post-TFA pregnancies reported normal outcomes. That prior series did not include postmarket cases in the United States, as the Sonata® System was initially cleared and used in Europe. This is a substantive update of known pregnancies with the Sonata System since June 2011, and includes pregnancies in Europe, Mexico, and the US. Methods: TFA was carried out under both clinical trial and postmarket use to treat symptomatic uterine fibroids. All post-TFA pregnancies reported by physicians with their patient's consent were included. Results: 89 pregnancies and 55 deliveries have occurred among 72 women treated with the Sonata System. This includes 8 women who conceived more than once after TFA. Completed pregnancies (n = 62 women) include 19 vaginal deliveries, 35 Cesarean sections, 5 therapeutic abortions, 1 ectopic pregnancy, and 1 delivery by an unknown route. Ten pregnancies are ongoing. Mean birthweight was 3276.7 ± 587.3 g. Ten women experienced 18 first-trimester spontaneous abortions (SAbs), with 10 of the 18 SAbs (55.6%) occurring between two patients with a history of recurrent abortion. The SAb rate was 22.8%, inclusive of these two patients, and 10.1% if they were excluded as outliers. There were no instances of uterine rupture, placenta accreta spectrum, or stillbirth. Conclusions: This case series, the largest to date for any hyperthermic ablation modality, suggests that TFA with the Sonata System could be a feasible, safe treatment option regarding eventual pregnancy in women with symptomatic uterine fibroids.
Collapse
Affiliation(s)
| | | | - David Toub
- Medical Affairs, Gynesonics, Redwood City, CA 94063, USA
| |
Collapse
|
3
|
Allen A, Schembri M, Parvataneni R, Waetjen LE, Varon S, Salamat-Saberi N, Tassone S, Williams N, Kho KA, Jacoby VL. Pregnancy Outcomes After Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas Compared With Myomectomy. Obstet Gynecol 2024; 143:612-618. [PMID: 38422502 DOI: 10.1097/aog.0000000000005548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare pregnancy outcomes after laparoscopic radiofrequency ablation and myomectomy. METHODS The ULTRA (Uterine Leiomyoma Treatment With Radiofrequency Ablation) study is an ongoing multicenter prospective cohort study with longitudinal follow-up up to 5 years comparing outcomes of radiofrequency ablation with myomectomy in premenopausal women older than age 21 years with symptomatic uterine leiomyomas. Participants were queried every 6 months after surgery to assess the incidence of pregnancy and pregnancy outcomes. RESULTS Among 539 women enrolled in ULTRA, a total of 37 participants (mean age at first pregnancy 35.0±4.7 years) conceived 43 times as of March 2023 (22 radiofrequency ablation, 21 myomectomy). The average length of follow-up time after all procedures was 2.5±1.0 years. The baseline miscarriage rate in the study population was 33.3%. In participants who underwent radiofrequency ablation, 9 of 22 pregnancies (40.9%, 95% CI, 20.3-61.5%) ended in first-trimester miscarriage, 11 resulted in live births (50.0%, 95% CI, 29.1-70.9%), one resulted fetal death at 30 weeks of gestation, and one resulted in uterine rupture during miscarriage treatment with misoprostol 10 weeks after radiofrequency ablation. Among the live births in the radiofrequency ablation group, 45.5% were by vaginal delivery. In the myomectomy group, 9 of 21 pregnancies (42.9%, 95% CI, 21.7-64.0%) ended in first-trimester miscarriage and 12 resulted in live births (57.1%, 95% CI, 36.0-78.3%). There were no significant differences in the likelihood of live birth or miscarriage between the study groups. CONCLUSION Full-term pregnancy and vaginal delivery are achievable after radiofrequency ablation of leiomyomas. However, in this interim analysis, the miscarriage rate in both radiofrequency ablation and myomectomy groups was higher than expected for women in this age group. Long-term data collection in the ongoing ULTRA study aims to further understand pregnancy outcomes after radiofrequency ablation compared with myomectomy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT0210094.
Collapse
Affiliation(s)
- Antoinette Allen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, the Departments of Obstetrics and Gynecology, University of California, Los Angeles, University of California, Davis, University of California, San Diego, and University of California, Irvine, and the University of California Fibroid Network, California; Tassone Advanced ObGyn, Round Rock, Texas; the Gynecological Institute of Chicago, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Perez Navarro M, Cazzaniga J, Esquenazi B. Uterine Leiomyoma Journey With Acessa ProVu System Using General Anesthesia Under Laparoscopic Ultrasound Guidance: A Case Report. Cureus 2024; 16:e54006. [PMID: 38476789 PMCID: PMC10929582 DOI: 10.7759/cureus.54006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/11/2024] [Indexed: 03/14/2024] Open
Abstract
This case report details the evaluation and management of a 40-year-old woman presenting with heavy menstrual bleeding and severe dysmenorrhea. Despite three months of combined oral contraceptives, symptoms persisted. The patient denied other systemic symptoms, with no weight loss, fatigue, or urinary/fecal symptoms. No visual, cardiovascular, pulmonary, abdominal, neurological, or mental health issues were reported. Pelvic imaging revealed a 7 cm × 4.3 cm FIGO 4 fibroid. The chosen treatment was laparoscopic radiofrequency ablation (Acessa) due to its efficacy, safety, and faster recovery. The case highlights the importance of a comprehensive approach to diagnosing and treating abnormal uterine bleeding.
Collapse
Affiliation(s)
- Merlin Perez Navarro
- Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Juliana Cazzaniga
- Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Benny Esquenazi
- Obstetrics and Gynecology, Memorial Healthcare, Pembroke Pines, USA
| |
Collapse
|
5
|
Kwon CS, Abu-Alnadi ND. Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation. Semin Intervent Radiol 2023; 40:335-341. [PMID: 37575346 PMCID: PMC10415057 DOI: 10.1055/s-0043-1770734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes.
Collapse
Affiliation(s)
- Caroline S. Kwon
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Noor Dasouki Abu-Alnadi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
6
|
Young RJ, Puma L, Latham M, Kho KA. Radiofrequency Ablation for Treatment of Leiomyomas: Review of the Manufacturer and User Facility Device Experience (MAUDE) Database. Obstet Gynecol 2023; 142:147-150. [PMID: 37348092 DOI: 10.1097/aog.0000000000005213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 06/24/2023]
Abstract
Radiofrequency ablation (RFA) is a relatively novel, increasingly popular treatment option for leiomyomas. We studied medical device-related reports of leiomyoma RFA devices to determine whether there are emerging device-related issues. The Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried from 2012 through November 2022. Sixty unique reports, including adverse events and device malfunctions, were analyzed for both laparoscopic and transcervical RFA devices. Forty-three injury reports were reviewed. The most common adverse event was infection. Of the injury cases, 34.9% required additional surgical intervention. Although the details of each event are limited, these reports highlight the importance of postmarket surveillance of new technologies and the necessity of improving the current system of implementation and monitoring.
Collapse
Affiliation(s)
- Riley J Young
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | |
Collapse
|
7
|
Stewart KA, Greenberg JA, Kho KA, Cohen Rassier SL. Radiofrequency Ablation of Leiomyomas. Obstet Gynecol 2023:00006250-990000000-00745. [PMID: 37053594 DOI: 10.1097/aog.0000000000005196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 04/15/2023]
Abstract
Radiofrequency ablation (RFA) of leiomyomas represents a significant advancement in the treatment of this common uterine condition. In the appropriately selected patient, both laparoscopic and transcervical options provide effective treatment for bleeding and bulk symptoms in a uterine-sparing manner. Compared with other minimally invasive leiomyoma treatment options, RFA procedures have comparable or favorable safety profiles, recovery timelines, and reintervention rates. Data on future fertility and pregnancy are limited, although early reports are promising.
Collapse
Affiliation(s)
- Kelsey A Stewart
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota; the Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Division of Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; and the Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | |
Collapse
|
8
|
The current and future state of surgery in reproductive endocrinology. Curr Opin Obstet Gynecol 2022; 34:164-171. [PMID: 35895956 DOI: 10.1097/gco.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The last decade has witnessed a radical change in the field of reproductive surgery. The increasing success of in-vitro fertilization (IVF) has caused a huge shift in emphasis with many downstream consequences. This review outlines the changes and provides insight into the future of reproductive surgery. RECENT FINDINGS With compelling evidence that IVF overcomes the detrimental effects of endometriosis on infertility and with two new oral medications available for management of endometriosis, momentum is shifting towards nonsurgical management of endometriosis. There is increasing recognition that except for submucous myomas, other myomas are unlikely to affect fertility and miscarriage. This, in addition to many emerging alternative modalities for management of myomas (oral GnRH antagonists, radiofrequency ablation), is likely to further decrease classic myomectomies but provide alternative, less invasive options. Caesarean scar defects have been recognized as having significant reproductive consequences and surgical management has become the standard of care. Fallopian tubes are now implicated in development of ovarian cancer, and as a result, salpingectomies are being performed in lieu of tubal ligations. Tubal anastomosis will soon become a historical surgery. Division of uterine septum remains controversial, and a clear answer will remain elusive. Uterine transplant is the single most significant advance in reproductive surgery in the past century. SUMMARY Reproductive surgery is evolving with the times. Although some surgical techniques will become historical, others will become mainstream.
Collapse
|
9
|
Current Trends in the Evaluation and Management of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Polin M, Hur HC. Radiofrequency Ablation of Uterine Fibroids and Pregnancy Outcomes: An Updated Review of the Literature. J Minim Invasive Gynecol 2022; 29:709-715. [PMID: 35123041 DOI: 10.1016/j.jmig.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide a systematic review of pregnancy outcomes after radiofrequency ablation of uterine fibroids. DATA SOURCES A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and EMBASE, from database inception until October 2021. METHODS OF STUDY SELECTION Two reviewers conducted independent literature searches. Studies that met criteria based on title and abstract underwent full text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical radiofrequency ablation (RFA) of fibroids. TABULATION, INTEGRATION, AND RESULTS 405 publications were initially identified and screened, 39 underwent full text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range 27 to 46 years). The majority of patients had between 1 and 3 fibroids ablated, and fibroid size ranged from less than 2 centimeters to 12.5 centimeters. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: 1 placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation, and no fetal complications. The spontaneous abortion rate was comparable to the general obstetric population. CONCLUSION Almost all pregnancies after radiofrequency ablation of fibroids were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency fibroid ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
Collapse
Affiliation(s)
- Melanie Polin
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York.
| | - Hye-Chun Hur
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
11
|
Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Christoffel L, Bends R, Toub D, Schiermeier S, Pschadka G, Engelhardt M, Quinn S, Hartmann M, Habiba M, Felberbaum R, Brössner A, Schippert C, Römer T. Pregnancy Outcomes After Transcervical Radiofrequency Ablation of Uterine Fibroids with the Sonata System. J Gynecol Surg 2021; 38:207-213. [PMID: 35785107 PMCID: PMC9245720 DOI: 10.1089/gyn.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To describe pregnancy outcomes in women who conceived after undergoing transcervical fibroid ablation (TFA) as treatment for symptomatic uterine fibroids. Materials and Methods: TFA was used to treat symptomatic uterine fibroids with radiofrequency energy, both under clinical trial protocol and commercial usage in hospitals in Europe, the United Kingdom, Mexico, and the United States. All women who reported pregnancies to their physicians after undergoing TFA with the Sonata® System and provided consent for use of their data were included. Results: There have been 36 pregnancies representing 20 deliveries among 28 women who were treated with TFA. Five women conceived more than once postablation, and four conceived as a result of assisted reproductive technology (ART). Outcomes include 8 vaginal deliveries, 12 Cesarean sections, 3 therapeutic abortions, and 8 first trimester spontaneous abortions (four occurring in a patient with a history of recurrent pregnancy loss and an immunologic disorder). Five women are currently pregnant, two of whom previously delivered after TFA. There were no 5-minute Apgar scores <7, and all neonates weighed >2500 g. All deliveries occurred at ≥37 weeks except for one delivery at 35 6/7 weeks. There were no uterine ruptures or abnormal placentation and no reports of postpartum hemorrhage or stillbirths. Ablated fibroids included transmural, submucous, and intramural myomata up to 7 cm in diameter. Conclusions: Normal pregnancy outcomes at term have occurred after TFA with the Sonata System, including in women with recurrent abortion and in those undergoing ART. There were no instances of low Apgar scores, low birthweight, stillbirth, postpartum hemorrhage, or uterine rupture (FAST-EU, NCT01226290; SONATA, NCT02228174; SAGE, NCT03 118037). (J GYNECOL SURG 38:207)
Collapse
Affiliation(s)
- Ladina Christoffel
- Chefärztin Gynäkologie/Geburtshilfe, Spital Oberengadin, Samedan, Switzerland
| | - Ralf Bends
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
| | - David Toub
- Gynesonics, Redwood City, California, USA
| | - Sven Schiermeier
- Zentrum für Frauenheilkunde und Geburtshilfe, Marien Hospital, Witten, Germany
| | | | | | - Stephen Quinn
- Department of Gynaecology, St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | | | - Marwan Habiba
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | | | - Thomas Römer
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
| |
Collapse
|
13
|
Abstract
Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy (1, 2), which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication (3).
Collapse
|
14
|
Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice. J Minim Invasive Gynecol 2020; 27:915-925. [DOI: 10.1016/j.jmig.2019.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/03/2019] [Accepted: 07/27/2019] [Indexed: 11/23/2022]
|