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Zhang Q, Liang X, Chen Z. An Updated Review of Thermal Ablation Technology for Uterine Fibroids and Adenomyosis: Focusing on Protecting Fertility. Int J Womens Health 2024; 16:1551-1563. [PMID: 39346931 PMCID: PMC11430362 DOI: 10.2147/ijwh.s473005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/15/2024] [Indexed: 10/01/2024] Open
Abstract
There is a growing trend towards minimally invasive or noninvasive alternatives for gynecological disorders due to their rapid alleviation of symptom, expedited recovery, and minimal risks of postoperative complications. Thermal ablation technology has been commonly advocated as a minimally invasive therapeutic methods in recent years, including microwave ablation, radiofrequency ablation, and high-intensity focused ultrasound. The increasing application scenarios require updated and systematic research, and more evidence to promote their appropriate use. The objective of this review is to summarize the latest views of ablation from a prospective of fertility protection, endeavor to clarify the clinical value of thermal ablation technology in protecting fertility by assessing parameters such as ablation rates, alleviation of disease symptoms, re-intervention rates and post-treatment pregnancy rates. We review the clinical studies of ablation for uterine fibroids and adenomyosis treatment in the past 10 years, summarize the limitation and the prospects of its development in the treatment process, so as to provide clinicians with advice on the best practice. In the management of uterine fibroids and adenomyosis, thermal ablation technology offers improved fertility preservation and minimizes normal tissue injury compared to traditional surgical approaches for patients pursuing reproductive goals. In the future, thermal ablation technology will play a significantly enhanced role in preserving fertility for individuals requiring treatment for uterine fibroids and adenomyosis, guided by indications. But further research is still needed in the form of more extensive randomized prospective trials to provide stronger evidence supporting this perspective.
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Affiliation(s)
- Qing Zhang
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Xiaowen Liang
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Zhiyi Chen
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
- Department of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
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Chen I, Berman JM, Balk EM, Saldanha IJ, Kowalczewski E, Yi J, Zanotti S, Hilli MA, Kho KA. Radiofrequency ablation for the treatment of uterine fibroids: A systematic review and meta-analysis by the AAGL Practice Committee. J Minim Invasive Gynecol 2024:S1553-4650(24)00416-3. [PMID: 39277104 DOI: 10.1016/j.jmig.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To systematically review clinical and patient-reported outcomes after radiofrequency ablation (RFA) for the treatment of uterine fibroids. DATA SOURCES We searched Medline, EMBASE, Cochrane Registry of Controlled Trials (CENTRAL) on September 8, 2023, and requested additional data from industry sources. We included published, peer-reviewed studies of patient-centered outcomes of RFA when used for symptomatic fibroids. Abstracts and potentially relevant full-text articles were screened and data were extracted regarding study characteristics, arms, outcomes, and results, together with risk of bias assessment. METHODS OF STUDY SELECTION We included 30 studies published in 49 articles (3 randomized controlled trials, 1 nonrandomized comparative study, and 26 single-group studies, as well as 4 publications from the TRUST Study) with variable risks of bias. TABULATION, INTEGRATION, AND RESULTS The study populations were demographically diverse and clinically heterogeneous. Across studies, RFA treatment was associated with fibroid volume reduction of 46.0% (95% confidence interval [CI] 52.1, 40.0; 11 studies) at 3 months and 65.4% (95% CI 74.7, 56.1; 10 studies) at 12 months. All studies reported a decrease in proportion of patients experiencing abnormal, heavy, or prolonged menstrual bleeding, with the most substantial improvement within the first 3 months. Meta-analyses of health-related quality of life (HRQOL) scores demonstrated significant improvements in scores from baseline for Uterine Fibroid Symptoms and Quality of Life [UFS-QOL] (53.4, 95% CI 48.2, 58.5; 19 studies), EuroQol 5 Dimension [EQ-5D] (71.6, 95% CI 65.0, 78.1; 4 studies), and Symptom Severity Score [SSS] (52.2, 95% CI 46.4, 58.1; 17 studies), with a peak at 6 months on the UFS-QOL scale (88.0, 95% CI 83.0, 92.9; 11 studies), a peak at 24 months on the EuroQol-5D scale (88.3, 95% CI 86.0, 90.6; 2 studies), and a trough at 12 months for SSS (12.8, 95% CI 7.0, 18.6; 11 studies). Studies mostly demonstrated return to work and normal activities within 2 weeks. Reported unplanned hospitalizations were infrequent, and durations of hospital stay were generally short. Post-procedure complications were inconsistently reported, but assessed overall to be infrequent. Long-term need for medical and surgical re-intervention varied. Post-RFA hysterectomy rates ranged from 2/205 (1.0%) to 15/62 (24.1%) with variable follow-up periods ranging from 45 days to 74 months. Most studies did not include patients who desired to maintain fertility; thus, reproductive data are insufficient for interpretation. CONCLUSION There is a paucity of comparative studies, and the small number of RCTs are limited by lack of blinding. Few studies had the long-term follow-up time required to draw definitive conclusions regarding the durability of symptom relief. However, despite these limitations, there is overall agreement on several important clinical measures following RFA, such as decreased fibroid volume, improved uterine bleeding and improved quality of life. Future high quality randomized controlled trials with standardized outcomes measures are required to better characterize the use of RFA among fibroid patients.
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Affiliation(s)
- Innie Chen
- Ottawa Hospital Research Institute, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Ottawa, ON, Canada.
| | - Jay M Berman
- Wayne State University School of Medicine, Department of Obstetrics & Gynecology, Detroit, MI, USA.
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Ian J Saldanha
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Emilie Kowalczewski
- Ottawa Hospital Research Institute, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - Johnny Yi
- Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, USA.
| | - Salena Zanotti
- Cleveland Clinic, Department of Obstetrics and Gynecology, Avon, OH, USA.
| | - Mariam Al Hilli
- Cleveland Clinic, Department of Subspecialty Care for Women's Health, Cleveland, OH, USA.
| | - Kimberly A Kho
- University of Texas Southwestern Medical Center, Division of Gynecology, Department of Obstetrics & Gynecology, Dallas, TX, USA.
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Marín Martínez ME, Cruz-Melguizo S, Vaquero Argüello G, Engels Calvo V, De la Cruz Conty ML, Pérez Medina T. Transvaginal radiofrequency ablation: a therapeutic option for managing symptomatic uterine fibroids in women with reproductive desires. F S Rep 2024; 5:320-327. [PMID: 39381652 PMCID: PMC11456661 DOI: 10.1016/j.xfre.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 10/10/2024] Open
Abstract
Objective To evaluate whether transvaginal radiofrequency (RF) ablation of fibroids is a technique that can be offered to women with reproductive desires. Design Unicentric, prospective, observational study. Setting University Hospital. Patients Twenty-seven individuals who desired to become mothers after undergoing RF ablation for symptomatic fibroids. Interventions Transvaginal RF ablation for symptomatic fibroids with a maximum total volume of 145 cm3. Main Outcome Measures The reduction in the size of the fibroids, improvement of symptoms, and reproductive outcomes during the 24 months after the ablation. For patients who achieved pregnancy, we assessed the type of conception, course of gestation, type of delivery, neonatal outcomes, and occurrence of both maternal and fetal complications. Results A statistically significant reduction in symptoms related to the fibroids 6 months after the ablation was demonstrated through the implementation of the Symptom Severity Scale. No patient required hospitalization after the procedure, and on average from the third day after intervention, they resumed their work activities without the need for analgesics. Among those patients who attempted pregnancy during the 24-month follow-up period, 73.68 % (14/19) achieved motherhood. There were no cases of uterine rupture, premature birth, or intrauterine fetal death. Conclusions Radiofrequency ablation for fibroids seems to be a promising, safe, and low-complexity alternative that does not appear to interfere with the development of a normal term gestation.
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Affiliation(s)
| | - Sara Cruz-Melguizo
- Servicio de Ginecología y Obstetricia, Hospital Universitario San Jorge-Jaca, Huesca, Spain
| | - Gema Vaquero Argüello
- Servicio de Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Virginia Engels Calvo
- Unidad de Reproducción, Servicio de Ginecología, Hospital Universitario La Paz, Madrid, Spain
| | - Ma Luisa De la Cruz Conty
- Departamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Tirso Pérez Medina
- Servicio de Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Escalante Ariza D, Rodríguez García I, Ávila Cabreja JA, Hidalgo Carmona E. Outcomes of transvaginal radiofrequency ablation for symptomatic leiomyomas. J Gynecol Obstet Hum Reprod 2024; 53:102812. [PMID: 38851321 DOI: 10.1016/j.jogoh.2024.102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Describe the effect of transvaginal radiofrequency ablation for leiomyoma in symptomatic patients and post procedure follow-up. MATERIAL AND METHODS A retrospective forward-looking observational study was performed including 63 patients who underwent transvaginal radiofrequency ablation between January 2016 and December 2022 at San Cecilio University Hospital in Granada, Spain. The variables registered were: age, parity, the clinical features that lead to the medical visit and pre-surgical treatment. Prior to the procedure, leiomyoma location and volume were determined by transvaginal ultrasound. Follow-ups were scheduled at 6 and 12 months to evaluate symptom improvement, adverse outcomes, leiomyoma volume and if any necessary post-surgical treatment was required. RESULTS Mean leiomyoma volume at baseline, 6 months and 12 months was 83.3 (24.9-130.7), 42.4 (4.7-89.0) and 19.2 (1.9-80.4) cm3, respectively (p < .001). Significant differences were found between the baseline and 12 month visits (p < .001). At the annual follow-up, the mean rate of volume reduction was 79.5 %, being higher in women who reported symptom improvement compared to those who reported no change in symptom intensity from baseline (84.6% vs. 30.8 %). Patients with a lower initial volume and age over 40 were more likely to have treatment efficacy. 8 pregnancies were registered post procedure. CONCLUSION Radiofrequency is well tolerated, allowing for same-day discharge, rapid recovery and a safe approach for women who want to preserve their reproductive potential. Initial volume and age over 40 appear to be factors that should be considered in patient selection. Further studies are needed to continue evaluating the outcomes and identifying predictive factors.
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Affiliation(s)
- Daniela Escalante Ariza
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain.
| | - Isabel Rodríguez García
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
| | - José Alejandro Ávila Cabreja
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
| | - Esther Hidalgo Carmona
- From the Department of Obstetrics and Gynecology, San Cecilio University Hospital, Avenida del Conocimiento s/n, Granada, 18016, Spain
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Chen T, Ren Q, Ge Q, Wang F, Jin Y, Liu P, Ma Q. Application of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation for treating uterine fibroids: 24-month follow-up outcomes. Arch Gynecol Obstet 2024; 309:1043-1052. [PMID: 38194092 DOI: 10.1007/s00404-023-07334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To determine the ablation efficacy of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation (PMWA), to investigate whether the risk of damage to adjacent organs and endometrium due to this technique can be reduced or even avoided. We also evaluated the clinical efficacy of this technique in the treatment of uterine fibroids of different sizes and at different locations over a 24-month follow-up period. METHODS This study included 50 patients with uterine fibroids who underwent transabdominal ultrasound- and laparoscopy-guided PMWA from August 2018 to July 2020. Lesions were confirmed by pathology. The technical efficacy and complications of PMWA were assessed. The lesion diameter, lesion volume, lesion location, and contrast-enhanced ultrasound (CEUS) features before PMWA and within 24 h after PMWA were recorded. Magnetic resonance imaging (MRI) was used for follow-up at 3 and 6 months after PMWA. Transvaginal ultrasound was used for follow-up at 24 months after PMWA. RESULTS A total of 50 patients with uterine fibroids received treatment. The median ablation rate of uterine fibroids was 97.21%. The mean lesion volume reduction rates were 32.63%, 57.26%, and 92.64% at 3, 6, and 24 months after treatment, respectively. The size and location of uterine fibroids did not significantly affect the ablation rate and the rate of lesion volume reduction. No major complication was found during and after the procedure. CONCLUSION Transabdominal ultrasound- and laparoscopy-guided PMWA can be utilized to safely enhance the ablation rate while minimizing ablation time and avoiding harm to adjacent organs and the endometrium. This technique is applicable for treating uterine fibroids of different sizes and at varying locations. TRIAL REGISTRATION NUMBER ChiCTR-IPR-17011910, and date of trial registration: 08/07/2017.
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Affiliation(s)
- Tong Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qiongzhen Ren
- Department of Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiuyan Ge
- Department of Ultrasound, Jiang Yin Maternal and Child Health Hospital, Wuxi, Jiangsu, China
| | - Fei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Yuma Jin
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Peiqing Liu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qi Ma
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.
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Vitale SG, Saponara S, Sicilia G, Klarić M, Sorrentino F, D'Alterio MN, Nappi L, Angioni S. Hysteroscopic diode laser myolysis: from a case series to literature review of incisionless myolysis techniques for managing heavy menstrual bleeding in premenopausal women. Arch Gynecol Obstet 2024; 309:949-959. [PMID: 37831177 PMCID: PMC10866768 DOI: 10.1007/s00404-023-07218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/02/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This case series examined the safety and effectiveness of hysteroscopic myolysis using laser-induced interstitial thermo-therapy (LITT) for treating heavy menstrual bleeding (HMB) in premenopausal women with FIGO type 1 or 2 uterine fibroids, not planning for future fertility. Additionally, a comprehensive review of innovative, minimally invasive, incisionless myolysis techniques was conducted. METHODS Women with HMB, sonographically diagnosed with a single FIGO type 1 or 2 fibroid, underwent hysteroscopic myolysis using the Leonardo® diode laser. Effectiveness was assessed via transvaginal ultrasound measurement of myoma size, volume and vascularization pre and post-procedure. Moreover, we also evaluated any improvements in symptoms using the Pictorial Blood Loss Assessment Chart (PBAC score) scores. RESULTS The procedure resulted in significant HMB reductions and noticeable fibroid size, volume, and vascularization decrease in all three patients, with no reported complications. The literature review revealed both advantages and limitations of the minimally invasive, incisionless myolysis techniques. CONCLUSIONS Hysteroscopic laser myolysis is a safe and effective therapeutic intervention for patients experiencing HMB, diagnosed with FIGO type 1 or 2 fibroids, and not planning for future fertility. The procedure resulted in significant reductions in menstrual blood loss and fibroid size. Despite the promising results, it is essential to note the limitations of this report, including its case series design, a small number of patients, and a short follow-up period. Further research is necessary to confirm these results.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Gilda Sicilia
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Marko Klarić
- Clinical Hospital Center of Rijeka, Department of Obstetrics and Gynaecology, Rijeka, Croatia
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Santalla-Hernández A, Naveiro-Fuentes M, Benito-Villena R, Villegas-Alcazar J, López-Criado MS, Lara-Serrano A, Parra JF, Alcázar JL, Pelayo-Delgado I. Complications of transvaginal radiofrequency ablation of fibroids: A 5-year experience. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100244. [PMID: 37869066 PMCID: PMC10587728 DOI: 10.1016/j.eurox.2023.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Introduction Transvaginal radiofrequency ablation is a relatively noninvasive approach for the treatment of fibroids in patients who do not wish to undergo conventional surgery. Information on potential complications of this novel technique is very scarce. Methods Retrospective, descriptive, epidemiological study of 115 patients who underwent transvaginal radiofrequency ablation of fibroids and for whom complications were recorded. Results We performed 115 transvaginal radiofrequency ablation procedures, we recorded a total of 11 complications (9.6%; 95% CI, 3.8-14.8). Of these, 8 (7.0%) were classified as Clavien-Dindo type I, 1 (0.9%,) as type II, and 2 (1.7%) as type IIIb (severe). No other complications were recorded in a year follow-up. Conclusion Transvaginal radiofrequency ablation is a treatment option that makes it possible to treat fibroids that are difficult to manage using other techniques. Few associated complications have been described, and most of them are mild.
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Affiliation(s)
- Angel Santalla-Hernández
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Mariña Naveiro-Fuentes
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Rebeca Benito-Villena
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jesus Villegas-Alcazar
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | | | - Ana Lara-Serrano
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jorge Fernández Parra
- Obstetrics and Gynecology department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- PhD. Program in clinical medicine and Public Health, University of Granada,18006 Granada, Spain
| | - Juan Luis Alcázar
- Obstetrics and Gynecology Department. Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Irene Pelayo-Delgado
- Obstetrics and Gynecology Department, Ramón y Cajal University Hospital, Faculty of Medicine Alcala de Henares University, 28034 Madrid, Spain
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Effectiveness and Safety of Ultrasound-guided Percutaneous Microwave Ablation for a Single Uterine Fibroid Greater than 300 cm 3. J Minim Invasive Gynecol 2022; 30:290-299. [PMID: 36563871 DOI: 10.1016/j.jmig.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness and safety of ultrasound-guided percutaneous microwave ablation (MWA) for a single uterine fibroid greater than 300 cm3. DESIGN Retrospective observational study. SETTING China-Japan Union Hospital of Jilin University, China. PATIENTS Thirty-seven patients each with a single fibroid greater than 300 cm3 diagnosed by ultrasound and core needle biopsy. INTERVENTIONS Ultrasound-guided percutaneous MWA. MEASUREMENTS AND MAIN RESULTS All patients were followed up for 12 months postoperatively to assess the postoperative lesion volume reduction rate, degree of symptomatic relief, improvements in quality of life, and occurrence of adverse events. All 37 patients met the criteria for complete ablation, and the lesion volume significantly decreased from 334.28 cm3 (95% confidence interval [CI] 326.75-366.73) preoperatively to 52.01 cm3 (95% CI, 46.95-74.69) at the 12-month follow-up (difference: 280.15 cm3; 95% CI, 267.92-294.65; p <.001). The lesion volume reduction rates at 1, 3, 6, and 12 months postoperatively were 27.30% (95% CI, 24.12-31.45), 52.90% (95% CI, 47.95-55.80), 67.90% (95% CI, 63.03-70.77), and 84.00% (95% CI, 80.22-85.94), respectively. The differences in the preoperative and postoperative Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire scores were significant (p <.01). The hemoglobin levels of the anemic patients were significantly elevated after the procedure (p <.001). Of the 37 patients in this study, 29 patients (78.38%) had a highly significant treatment effect, and 8 patients (21.62%) had a significant treatment effect. Seventeen patients (45.95%) had Society of Interventional Radiology grade A to B adverse effects that required no clinical intervention or only simple clinical intervention. CONCLUSION Ultrasound-guided percutaneous MWA has good clinical efficacy and high safety in the treatment of a single uterine fibroid greater than 300 cm3.
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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.
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