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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.
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Affiliation(s)
| | | | - David Toub
- Medical Affairs, Gynesonics, Redwood City, CA 94063, USA
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2
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Bertogli H, Lucot JP, Lafourcade J, Warembourg S, Detchev R, Nguyen Ba E, Dubernard G, Philip CA. [Laparoscopic ultrasound-guided radiofrequency ablation of uterine fibroid: A retrospective study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00191-0. [PMID: 38604536 DOI: 10.1016/j.gofs.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas. MATERIAL AND METHODS Thirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months. RESULTS A total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13-34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83-14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14-4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9-168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92-43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83-37.85]. P<0.001). No severe adverse event has been reported. CONCLUSION In this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.
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Affiliation(s)
- Helloïse Bertogli
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | | | | | - Sophie Warembourg
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | | | - Emilie Nguyen Ba
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - Gil Dubernard
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France
| | - Charles-André Philip
- Hospices civils de Lyon, Croix Rousse Hospital, 103, grande rue de la Croix Rousse, 69004 Lyon, France.
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3
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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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4
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Lin M, He J, Lyu G, Li Z, Li X, Qiu S, Chen S, Zhang T, Wang J, Li S. Combined transabdominal and transvaginal ultrasound-guided percutaneous microwave ablation of uterine myomas: an effective monitoring technique. Int J Hyperthermia 2022; 40:2154576. [PMID: 36535945 DOI: 10.1080/02656736.2022.2154576] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM). METHOD This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group. RESULTS In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm. CONCLUSION TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.
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Affiliation(s)
- Min Lin
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jinghua He
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Guorong Lyu
- Collaborative Innovation Centre for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Quanzhou, China.,Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zuolin Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaolian Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Sihua Qiu
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shujin Chen
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Tingting Zhang
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jinyong Wang
- Department of Gynecology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shuiping Li
- Department of Ultrasound, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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5
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Xuan M, Wu C, Zhang J, Zhou F. Role of ultrasound-guided technique in the treatment of gynecologic diseases: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31329. [PMID: 36316879 PMCID: PMC9622639 DOI: 10.1097/md.0000000000031329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The efficacy and safety of ultrasound-guided interventional procedures for gynecologic diseases have not been evaluated comprehensively. Therefore, we aimed to provide an evidence-based medical reference for clinical treatment in this meta-analysis. METHODS The literature searches were conducted in databases of PubMed, Embase, and Web of Science for eligible studies published from 2002 to May 2022. All literature was searched, screened, and reviewed by 2 researchers separately. RevMan 5.3.0 was used to analyze the relevant data. RESULTS A total of 12 articles consisting of 2854 patients were included. Compared with the control group, meta-analysis showed that ultrasound-guided technique in the experimental group was associated with a higher effective rate [risk ratio = 0.84, 95% confidence interval (CI) (0.84, 0.84)], a lower probability of recurrence [odds ratio = 0.13, 95% CI (0.13, 0.13), P < .00001], and a greater effective reintervention rate [odds ratio = 3.39, 95% CI (1.29, 8.86), P = .01]. However, it was not significantly associated with fewer adverse reactions. CONCLUSIONS Ultrasound-guided technique in treating gynecologic diseases exerted a positive effect and had fewer adverse reactions, which could be popularized and applied in clinical practice.
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Affiliation(s)
- Min Xuan
- Department of Ultrasound, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, People Republic of China
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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.
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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
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7
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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]
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8
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Santalla-Hernández Á, Naveiro-Fuentes M, Benito-Villena R, López-Criado MS, González-Paredes A, Parra JF. Efficacy, Complications and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas. J Minim Invasive Gynecol 2022; 29:743-752. [DOI: 10.1016/j.jmig.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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9
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Zhang J, Go VA, Blanck JF, Singh B. A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding. Reprod Sci 2021; 29:2786-2809. [PMID: 34480321 DOI: 10.1007/s43032-021-00722-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/22/2021] [Indexed: 12/09/2022]
Abstract
Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.
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Affiliation(s)
- Jiahui Zhang
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Virginia-Arlene Go
- Department of Obstetrics and Gynecology, Saint Joseph Hospital Denver, Denver, CO, USA
| | - Jaime Friel Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhuchitra Singh
- Division of Reproductive Sciences & Women's Health Research, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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10
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Hai N, Hou Q, Dong X, Guo R. Comparison between radiofrequency ablation combined with mifepristone and radiofrequency ablation for large uterine fibroids. Int J Hyperthermia 2021; 38:777-780. [PMID: 33980123 DOI: 10.1080/02656736.2021.1922763] [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: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of transvaginal ultrasound-guided (US-guided) radiofrequency ablation (RFA) combined with mifepristone for the treatment of large uterine fibroids. METHODS Between June 2016 and December 2018, a total of 30 patients with symptomatic uterine fibroids (≥5cm) who underwent transvaginal US-guided RFA combined with mifepristone were included in this retrospective study. A matching cohort of 30 patients underwent transvaginal US-guided RFA without mifepristone as controls. The technical efficacy, complications and mid-term treatment effectiveness were assessed and compared with the controls. RESULTS The mean volume of uterine fibroid was 168.3 ± 40.1 cm3. The mean ablation time was 23.5 ± 11.3 min in the combined treatment group, which was demonstrably less than that of the RFA group, which was 45.7 ± 6.8 min. The mean number of punctures was 2.2 ± 0.6 in the combined treatment group, which was significantly less than that of the RFA group. No major complications occurred. The mean percentages of regression of fibroid at 3 and 12 months after the course of the combined treatment were 73.3% and 90.1%, respectively, which were significantly more than those of the RFA group. Quality of life and symptom scores improved in both groups but to a greater extent in the combined treatment group. CONCLUSIONS US-guided RFA combined with mifepristone might be a simple, safe and effective alternative for the treatment of large uterine fibroids.
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Affiliation(s)
- Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China.,Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Qingxiang Hou
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Xiangping Dong
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China
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11
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Arnreiter C, Oppelt P. A Systematic Review of the Treatment of Uterine Myomas Using Transcervical Ultrasound-Guided Radiofrequency Ablation with the Sonata System. J Minim Invasive Gynecol 2021; 28:1462-1469. [PMID: 33892184 DOI: 10.1016/j.jmig.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the treatment success, possible side effects, and safety of radiofrequency ablation with the Sonata System. DATA SOURCES An electronic literature search in the PubMed and Medline databases was carried out from inception to August 2020. METHODS OF STUDY SELECTION The review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Keywords such as "Sonata," "transcervical ablation," and "uterine myoma" were used to identify all relevant articles independently by both authors. Full-text articles in English that reported at least 1 of the following outcomes were included in the study: reduction in perfused/total myoma volume, effect of treatment on bleeding intensity and myoma-related symptoms, number of surgical reinterventions, adverse events, return to activities of daily life, effects on surrounding tissue, and safety during pregnancy. TABULATION, INTEGRATION, AND RESULTS 10 studies matching the inclusion criteria were identified and used for further analysis. A reduction in total and perfused myoma volume of 63.2% and 64.5% was achieved. One of the studies showed a 53.8 ± 50.5% (n = 48) reduction in Menstrual Pictogram Score, and another study showed a 51.1 ± 40.9% (n = 142) reduction in Pictorial Blood Loss Assessment Chart at 12 months. 87.2% (n = 190) of the patients reported a clinically meaningful reduction in menstrual blood loss after 12 months. While Symptom Severity Scores dropped by 28.8 ± 19.3, 23.3 ± 23.7, and 23.7 ± 19.4 points at 3, 6, and 12 months, respectively, Health-Related Quality of Life Scores increased to 77.5 ± 22.0, 82.8 ± 19.0, and 83.3 ± 20.5 points. One study had an 8% reintervention rate after 12 months, and another study showed a 0.7% and 5.2% rate after 12 and 24 months. After an average of 64 months after ablation, the reintervention rate was 11.8%. Time to return to activities of daily life was 2.9 ± 2.5 days. No related complications during pregnancy and delivery were reported. CONCLUSION Radiofrequency ablation with the Sonata System represents a minimally invasive, organ-preserving treatment option in patients with symptomatic uterine myomas, associated with clinically meaningful improvement of myoma-related symptoms.
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Affiliation(s)
- Christina Arnreiter
- Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University, Linz, Austria (all authors).
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University, Linz, Austria (all authors)
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12
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Ierardi AM, Carnevale A, Pellegrino F, Stefano GD, Bonelli C, Renzulli M, Giganti M, Carrafiello G. Uterine Myomas: Extravascular Treatment. Semin Ultrasound CT MR 2020; 42:56-74. [PMID: 33541590 DOI: 10.1053/j.sult.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Uterine fibroids are common benign tumors that affect the female reproductive tract. They are responsible for considerable morbidity and deterioration of life quality. The main advantages offered by mini invasive techniques are low grade of invasiveness and short times of hospitalization. The most diffuse technique is uterine artery embolization (UAE). Common concerns with UAE include postprocedural pain, postembolization syndrome, and risk of infection. Image-guided thermal ablation techniques like radiofrequency ablation, percutaneous microwave ablation, and imaging-guided high-intensity focused ultrasound were introduced to overcome the side effects related to UAE and surgery. The aim of this review is to briefly analyze the ablative procedures and their role in the management of symptomatic fibroids, and to describe the safety profile and outcomes of these modalities.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Giuseppina Di Stefano
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Cristian Bonelli
- Healthcare Professional Department, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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13
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A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas. ACTA ACUST UNITED AC 2020; 56:medicina56030122. [PMID: 32178351 PMCID: PMC7143923 DOI: 10.3390/medicina56030122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 01/20/2023]
Abstract
Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), "Uterine Fibroid Symptom and Quality of Life (UFS-QOL)" questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%). Results: Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (p < 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (p < 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to -74.3% and -45.3% as well as -84.9% and -74.3%, respectively, at 1 and 12 months after RFM (p < 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (p < 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (p < 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids. Conclusion: Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids.
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Khaw SC, Anderson RA, Lui MW. Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids. Reprod Biomed Online 2020; 40:429-444. [DOI: 10.1016/j.rbmo.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
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15
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Lin XL, Hai N, Zhang J, Han ZY, Yu J, Liu FY, Dong XJ, Liang P. Comparison between microwave ablation and radiofrequency ablation for treating symptomatic uterine adenomyosis. Int J Hyperthermia 2020; 37:151-156. [PMID: 32024402 DOI: 10.1080/02656736.2019.1708481] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xiao Liang Lin
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi Yu Han
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Yi Liu
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xue Juan Dong
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Bradley LD, Pasic RP, Miller LE. Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies. J Laparoendosc Adv Surg Tech A 2019; 29:1507-1517. [PMID: 31702440 PMCID: PMC7387230 DOI: 10.1089/lap.2019.0550] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Radiofrequency ablation (RFA) has emerged as a safe and effective treatment option for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal, or transcervical approaches. The evidence regarding typical patient outcomes with RFA has not previously been examined in a comprehensive fashion. Materials and Methods: We performed a systematic review of prospective studies for treatment of uterine fibroids with RFA. Main outcomes were procedure time, patient recovery metrics, change in fibroid volume, symptom severity score (SSS), health-related quality of life (HRQL), and reinterventions. Data were analyzed with random effects meta-analysis and metaregression. Results: We identified 32 articles of 1283 unique patients (median age: 42 years) treated with laparoscopic RFA (19 articles), transvaginal RFA (8 articles), or transcervical fibroid ablation (5 articles). Mean procedure time was 49 minutes, time to discharge was 8.2 hours, time to normal activities was 5.2 days, and time to return to work was 5.1 days. At 12 months follow-up, fibroid volume decreased by 66%, HRQL increased by 39 points, and SSS decreased by 42 points (all P < .001 versus baseline). The annual cumulative rate of reinterventions due to fibroid-related symptoms was 4.2%, 8.2%, and 11.5% through 3 years. Conclusions: RFA of uterine fibroids significantly reduces fibroid volume, provides significant durable improvements in fibroid-related quality of life, and is associated with favorable reintervention rates.
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Affiliation(s)
- Linda D. Bradley
- Department of Obstetrics and Gynecology, Women's Health Institute, Center for Menstrual Disoders, Cleveland Clinic, Cleveland, Ohio
| | - Resad P. Pasic
- Department of Obstetrics and Gynecology, University of Louisville Hospital, Louisville, Kentucky
| | - Larry E. Miller
- Miller Scientific Consulting, Inc., Asheville, North Carolina
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Transvaginal Radiofrequency Ablation of Myomas: Technique, Outcomes, and Complications. J Laparoendosc Adv Surg Tech A 2019; 29:24-28. [DOI: 10.1089/lap.2018.0293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Turtulici G, Orlandi D, Dedone G, Mauri G, Fasciani A, Sirito R, Silvestri E. Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study. Int J Hyperthermia 2018; 35:97-104. [DOI: 10.1080/02656736.2018.1479778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Davide Orlandi
- Radiology Department, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Giorgia Dedone
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Italy
| | - Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Milan, Italy
| | | | - Rodolfo Sirito
- Gynecological Department, Ospedale Evangelico Internazionale, Genoa, Italy
| | - Enzo Silvestri
- Radiology Department, Ospedale Evangelico Internazionale, Genoa, Italy
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Bends R, Toub DB, Römer T. Normal spontaneous vaginal delivery after transcervical radiofrequency ablation of uterine fibroids: a case report. Int J Womens Health 2018; 10:367-369. [PMID: 30038526 PMCID: PMC6052928 DOI: 10.2147/ijwh.s165959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Transcervical radiofrequency ablation of uterine fibroids was performed on a patient in Germany, who subsequently conceived. This is the first report of a normal spontaneous vaginal delivery after fibroid ablation with the Sonata® System.
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Affiliation(s)
- Ralf Bends
- Department of Obstetrics and Gynecology, Evangelisches Klinikum Köln-Weyertal, Köln, Germany,
| | - David B Toub
- Department of Obstetrics and Gynecology, Albert Einstein Medical Center, Philadelphia PA, USA.,Medical Affairs, Gynesonics, Redwood City, CA, USA
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Evangelisches Klinikum Köln-Weyertal, Köln, Germany,
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Percutaneous High Frequency Microwave Ablation of Uterine Fibroids: Systematic Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2360107. [PMID: 29511672 PMCID: PMC5817312 DOI: 10.1155/2018/2360107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/29/2017] [Indexed: 01/20/2023]
Abstract
Uterine fibroids are the most common benign pelvic tumor of the female genital tract and tend to increase with age; they cause menorrhagia, dysmenorrhea, pelvic pressure symptoms, back pain, and subfertility. Currently, the management is based mainly on medical or surgical approaches. The nonsurgical and minimally invasive therapies are emerging approaches that to the state of the art include uterine artery embolization (UAE), image-guided thermal ablation techniques like magnetic resonance-guided focused ultrasound surgery (MRgFUS) or radiofrequency ablation (RF), and percutaneous microwave ablation (PMWA). The purpose of the present review is to describe feasibility results and safety of PMWA according to largest studies available in current literature. Moreover technical aspects of the procedure were analyzed providing important data on large scale about potential efficacy of PMWA in clinical setting. However larger studies with international registries and randomized, prospective trials are still needed to better demonstrate the expanding benefits of PMWA in the management of uterine fibroids.
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21
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Non-surgical Management of Myomas. J Minim Invasive Gynecol 2017; 25:229-236. [PMID: 28821471 DOI: 10.1016/j.jmig.2017.08.642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/24/2022]
Abstract
Uterine myomas are a common condition and the leading cause of hysterectomy. Clinically, myomas can be challenging because they range from asymptomatic to causing severe, debilitating symptoms and occur in many women before childbearing is complete. Thus, women often seek uterine-conserving and nonsurgical management of their myomas. In this review the available uterine-conserving treatment options from medical management through minimally invasive procedures are discussed. To the extent of research available, the sustainability of symptom improvement and the effects on future fertility are reviewed. Future research may lead to therapies that reduce the risks of major surgery, decrease side effects, and offer primary or secondary prevention options.
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Psychiatric outcomes after hysterectomy in women with uterine myoma: a population-based retrospective cohort study. Arch Womens Ment Health 2017; 20:487-494. [PMID: 28597115 DOI: 10.1007/s00737-017-0745-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
Controversy regarding psychological or psychiatric outcomes following hysterectomy still exists. The purpose of this study was to investigate the risk of postoperative psychiatric disorders in women with hysterectomy compared to that in women with uterus-conserving surgery for myomas by using population-based data from South Korea. This study was designed as a retrospective cohort study. We analyzed the National Health Insurance Service National Sample Cohort data including all administrative medical claims from 2002 to 2013. The study population, consisting of 9581 women, was defined as those diagnosed with uterine myoma who underwent medical procedures. The association between psychiatric and mood disorders and hysterectomy was assessed using Cox proportional hazard regression. During the study period, 1381 (14.4%) women experienced psychiatric disorders and 374 (3.9%) experienced mood disorders. The hazard ratio (HR) for psychiatric disorder was higher in women after hysterectomy than in women after uterus-conserving procedures (adjusted HR = 1.44; 95% CI = 1.27-1.64, p < 0.0001). In addition, the HR for mood disorders in women after hysterectomy was significantly higher than in women after uterus-conserving procedures (adjusted HR = 1.62; 95% CI = 1.26-2.08, p = 0.0002). Our study suggests that hysterectomy increased the risk of psychiatric disorders compared to uterus-conserving procedures in women with uterine myoma. Considering these findings, more focus on psychological responses in women following hysterectomy is needed, and appropriate psychosocial support or provisioning of information before or after procedures could reduce psychological distress.
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23
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Pregnancy Outcomes After Direct Uterine Myoma Thermal Ablation: Review of the Literature. J Minim Invasive Gynecol 2017; 24:538-545. [DOI: 10.1016/j.jmig.2017.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/22/2022]
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24
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Toub DB. A New Paradigm for Uterine Fibroid Treatment: Transcervical, Intrauterine Sonography-Guided Radiofrequency Ablation of Uterine Fibroids with the Sonata System. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017; 6:67-73. [PMID: 28357157 PMCID: PMC5350207 DOI: 10.1007/s13669-017-0194-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose of Review This article provides the current evidence related to transcervical radiofrequency ablation of uterine fibroids under integrated intrauterine sonography guidance (the Sonata System). Recent Findings Published data on the treatment of fibroids with the Sonata System has demonstrated significant median reductions in total (73.3%) and perfused (73.3%) uterine fibroid volume, menstrual bleeding (72.3%), symptom severity (62.5%), and improvements in health-related quality of life (127%) at 12 months post-ablation. A clinical trial under an FDA Investigational Device Exemption is in progress. Summary The Sonata System is a promising treatment modality for uterine fibroids. As an incisionless, minimally invasive treatment that does not require general anesthesia or hospitalization, it has the potential for redefining the current paradigm for management of symptomatic fibroids.
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Affiliation(s)
- David B Toub
- Gynesonics, Inc, 301 Galveston Drive, Redwood City, CA 94063 USA.,Department of Obstetrics and Gynecology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141 USA
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25
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Abstract
Laparoscopic, ultrasound-guided radiofrequency ablation (RFA) is a new, FDA-cleared uterine sparing, outpatient procedure for uterine fibroids. The procedure utilizes recent technological advancements in instrumentation and imaging, allowing surgeons to treat numerous fibroids of varying size and location in a minimally invasive fashion. Early and mid-term data from multi-center clinical trials have demonstrated safety and efficacy, with resolution or improvement of symptoms and significant volume reduction. Re-intervention rates for fibroid symptoms have been low. The procedure is well tolerated with a typically uneventful and rapid recovery requiring NSAIDs only for postoperative pain. While post RFA pregnancy data are limited, the results are promising.
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Affiliation(s)
- Bruce B. Lee
- Santa Monica-UCLA Medical Center, 1250 16th Street, Santa Monica, CA 90404 USA
- Roxbury Clinic and Surgery Center, 465 N Roxbury Dr. #1001, Beverly Hills, CA 90210 USA
- Ventura Surgery Center, 1752 S Victoria Ave #A, Ventura, CA 93003 USA
- Division of Minimally Invasive Surgery, Department of OBGYN, University of California|, Los Angeles, CA USA
| | - Steve P. Yu
- Division of Minimally Invasive Surgery, Department of OBGYN, University of California|, Los Angeles, CA USA
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Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation. Clin Obstet Gynecol 2016; 59:85-92. [PMID: 26670832 DOI: 10.1097/grf.0000000000000168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased awareness regarding risks associated with intracorporeal electromechanical, or power, morcellation has urged surgeons to develop alternative methods for tissue extraction that may mitigate some of these risks during surgery. The use of containment systems during laparoscopic procedures has allowed surgeons to continue to offer and perform myomectomies that still benefit from being minimally invasive but which may minimize the risk of inadvertent tissue dispersion. Here, we will review techniques for performing contained tissue fragmentation without the use of a power morcellator.
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Hai N, Hou Q, Ding X, Dong X, Jin M. Ultrasound-guided transcervical radiofrequency ablation for symptomatic uterine adenomyosis. Br J Radiol 2016; 90:20160119. [PMID: 27792415 DOI: 10.1259/bjr.20160119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the midterm outcomes of transvaginal ultrasound-guided radiofrequency ablation (RFA) for the treatment of symptomatic uterine adenomyosis. METHODS 87 patients with symptomatic uterine adenomyosis, who met the inclusion criteria, were enrolled in our study from January 2013 to October 2015. All of the patients underwent transvaginal ultrasound-guided RFA and were followed up for 12 months. Assessment end points included uterus volume reduction rate, lesion regression rate, dysmenorrhoeal score, symptom severity score (SSS) and adverse events. RESULTS In all 87 patients, 81 patients fulfilled the follow-up evaluations post-ablation. The mean uterine volume reduction rate was 35.8% at 1 month, 40.8% at 6 months and 41.2% at 12 months post-ablation. Dysmenorrhoea and SSS statistically significantly declined. Reintervention rate was 18.5%. Two patients developed intrauterine adhesion after ablation. No serious complications including penetration or burn injuries of the nearby organs were observed. CONCLUSION Ultrasound-guided RFA might be a safe and effective minimally invasive alternative in the treatment of symptomatic adenomyosis. Advances in knowledge: This is the first study to evaluate the efficacy and safety of ultrasound-guided RFA for the treatment of adenomyosis to our knowledge. This is also the first study to provide various changes of intrauterine cavity after this treatment.
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Affiliation(s)
- Ning Hai
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Qingxiang Hou
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Xiaoping Ding
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Xiangping Dong
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
| | - Meijuan Jin
- Department of Gynecology, PLA Rocket Force General Hospital, Beijing, China
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Review of nonsurgical/minimally invasive treatments and open myomectomy for uterine fibroids. Curr Opin Obstet Gynecol 2016; 27:391-7. [PMID: 26536205 DOI: 10.1097/gco.0000000000000223] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The main purpose of this review is to collect the most recent evidence with regards to safety and effectiveness of the nonsurgical and minimally invasive treatment options for uterine fibroids. RECENT FINDINGS Among the nonsurgical options, uterine artery embolization (UAE), and in eligible patients, magnetic resonance-guided high-intensity focused ultrasound (MRgFUS) are emerging as effective alternatives to surgical options for treatment of symptomatic fibroids. MRgFUS is comparable to UAE, and appears to be a cost effective treatment option, especially in older women, although long-term data are awaited. The transvaginal route for radiofrequency ablation is a promising new nonsurgical alternative, which needs to be studied in larger trials to establish its safety and efficacy.The laparoscopic myomectomy results in less postoperative pain, reduced febrile morbidity, and shorter hospital stay when compared with open laparotomy. The newer robotic approach is comparable to traditional laparoscopic technique in short surgical outcomes but is associated with higher costs. Hysteroscopic myoma resection is an effective surgical intervention for submucous fibroids and prior misoprostol use can help in reducing cervical lacerations. SUMMARY UAE and MRgFUS can be offered as an alternative nonsurgical option for eligible women with symptomatic fibroids. Laparoscopic myomectomy remains a safe and effective surgical option with advantage of less postoperative pain and faster recovery compared with open laparotomy for women who wish to retain their fertility options.
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Wu XJ, Guo Q, Cao BS, Tan LX, Zhang HY, Cai YR, Gao BL. Uterine Leiomyomas: Safety and Efficacy of US-guided Suprapubic Transvaginal Radiofrequency Ablation at 1-year Follow-up. Radiology 2016; 279:952-60. [DOI: 10.1148/radiol.2015142537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Luo X, Shu SR, Ma XF, Shuai HL. The Research of Feasibility and Efficacy of Radiofrequency Ablation in Treating Uterine Fibroids. Medicine (Baltimore) 2015; 94:e1956. [PMID: 26632689 PMCID: PMC5058958 DOI: 10.1097/md.0000000000001956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To explore the feasibility and efficacy of radiofrequency ablation in treating uterine fibroids.Ninety patients with multiple uterine fibroids, who had undergone hysterectomy were included in the study. After the uterus was resected, the temperature of 60, 80, 100°C were adopted to ablate the in vitro fibroid with each temperature dealing with 30 patients. Simultaneously, 5 patients were included, whose in vivo fibroid were ablated with the temperature of 100°C before the fibroids were removed after laparotomy. After the fibroids were ablated, the smooth muscle in the ablated center (group A), the ablated edge (group B) and 1 cm away from the ablated edge (group C) were taken. Then, the samples were stained with hematoxylin and eosin (HE) to examine the histopathological changes, and immunohistochemistry was performed to detect the expression of estrogen receptor (ER) and progesterone receptor (PR).After radiofrequency ablation, the ablated lesions were round, toast tan, and dry on gross appearance. There were no obvious tissue carbonization and there were distinct boundary from periphery tissue. In vitro: On automated analysis, the average optical density of ER and PR in group A, B, and C was lower than the control group (P < 0.05), and which were gradually raised with the increased distance to electrode. In the same treatment group, ER optical density was gradually decreased with the increased temperature among 3 different groups. The PR optical density was decreased with the increased temperature under different temperatures in group A and group B, there was significant difference among groups (P < 0.05). But in group C, there was no difference in PR expression among the temperature of 60, 80, and 100°C (P > 0.05). In vivo: Compared with the control group, the average optical density of ER and PR were significantly different among group A, B, and C (P < 0.05), what's more, it was gradually raised with the increased distance to electrode.After radiofrequency ablation, the tissues displayed coagulative necrosis, and decreased ER and PR expression. Radiofrequency ablation may be considered a minimally invasive alternative for those women who wish to retain their reproductive potential. Eighty degree Celsius was expected to be the optimum temperature in radiofrequency ablation treatment of uterine fibroid.
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Affiliation(s)
- Xin Luo
- From Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, Guangzhou, People's Republic of China
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Hai N, Ding X. Intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. J Obstet Gynaecol Res 2015; 41:1851-4. [PMID: 26311404 DOI: 10.1111/jog.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/16/2015] [Accepted: 06/06/2015] [Indexed: 11/28/2022]
Abstract
Transvaginal ultrasound-guided radiofrequency myolysis offers an alternative to surgery for symptomatic uterine myomas, with encouraging efficacy and safety, suggesting low complication rates. This case study describes the first reported intrauterine adhesion after transvaginal ultrasound-guided radiofrequency myolysis. Women who desire further pregnancy should be warned about the particular risk of intrauterine adhesion of radiofrequency myolysis.
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Affiliation(s)
- Ning Hai
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
| | - Xiaoping Ding
- Department of Gynecology, The PLA Second Artillery Force General Hospital, Beijing, China
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32
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Rectouterine fistula after laparoscopic ultrasound-guided radiofrequency ablation of a uterine fibroid. Obstet Gynecol Sci 2014; 57:553-6. [PMID: 25469349 PMCID: PMC4245354 DOI: 10.5468/ogs.2014.57.6.553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/04/2014] [Accepted: 06/18/2014] [Indexed: 11/22/2022] Open
Abstract
In the conservative management of uterine fibroids is radiofrequency ablation (RFA) considered to be one of the safe, effective and minimal invasive approaches in selected women who desire to retain their uterus. Few studies were conducted on its adverse outcomes and most of the reported complications were minor events such as pain, discharge, adhesion which didn't require any intervention. However, although safe and effective, the RFA of a uterine myoma can be the cause for severe complications such as penetration and burn injuries of pelvic organs. In general, a rectouterine fistula is one of the rarest complications but can lead to serious adverse outcomes. Herein, to our knowledge, we report the first case involving a rectouterine fistula after laparoscopic ultrasound-guided RFA of a uterine myoma with pelvic endometriosis. In addition, we provide a brief review of the relevant literature.
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Yin G, Chen M, Yang S, Li J, Zhu T, Zhao X. Treatment of uterine myomas by radiofrequency thermal ablation: a 10-year retrospective cohort study. Reprod Sci 2014; 22:609-14. [PMID: 25355802 DOI: 10.1177/1933719114556481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients' selection criteria, effectiveness, and safety of radiofrequency thermal ablation (RFTA) therapy for uterine myomas (UM) were assessed using a 10-year retrospective cohort study. From July 2001 to July 2011, a total of 1216 patients treated for UM were divided into 2 groups. Group A consisted of 476 premenopause patients, average age 36.5 ± 8.5 years, average number of myomas 1.7 ± 0.9, and average diameter of myomas 4.5 ± 1.5 cm, and group B consisted of 740 menopause patients, average age 48.5 ± 3.5 years, average number of myomas 2.6 ± 1.3, and average diameter of myomas 5.0 ± 2.5 cm. Average follow-up period was 36.5 ± 11.5 months. At 1, 3, 6, 12, and 24 months after RFTA, average diameters of myomas in group A were 3.8, 3.0, 2.7, 2.4, and 2.2 cm, respectively, and 47.7% (227 of 476) of patients had tumor trace at 12 months after RFTA. In group B, the results were 4.7, 3.7, 3.3, 2.3, and 2.3 cm, respectively, and 58.8% (435 of 740) of patients had tumor trace at 12 months after RFTA. Three months after treatment, myoma volumes were significantly reduced in both the groups (P < .01), and group B had higher rate of tumor trace at 12 months after RFTA than group A (P < .05). Clinical symptoms and health-related quality-of-life outcome (HRQL) were significantly improved after RFTA in both groups and the postoperative recurrence rate of UM was significantly higher in group A at 10.7% (51 of 476) than group B at 2.4% (18 of 740; P < .05). Radiofrequency thermal ablation is an excellent minimally invasive treatment for UM smaller than 5.0 cm in diameter.
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Affiliation(s)
- Geping Yin
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Ming Chen
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Shujun Yang
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Juan Li
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Tongyu Zhu
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Xiaoli Zhao
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
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Pucher PH, Sodergren MH, Lord AC, Teare J, Yang GZ, Darzi A. Consumer demand for surgical innovation: a systematic review of public perception of NOTES. Surg Endosc 2014; 29:774-80. [PMID: 25159629 DOI: 10.1007/s00464-014-3769-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/22/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly "scarless surgery" is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique. METHODS A comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance. RESULTS Initial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor. CONCLUSIONS This review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required.
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Affiliation(s)
- Philip H Pucher
- Department of Surgery, St Mary's Hospital, Imperial College London, London, W2 1NY, UK
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Jiang X, Thapa A, Lu J, Bhujohory V, Liu Y, Qiao S. Ultrasound-guided transvaginal radiofrequency myolysis for symptomatic uterine myomas. Eur J Obstet Gynecol Reprod Biol 2014; 177:38-43. [DOI: 10.1016/j.ejogrb.2014.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
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Ultrasound-Guided Percutaneous Microwave Ablation for Submucosal Uterine Fibroids. J Minim Invasive Gynecol 2014; 21:436-41. [DOI: 10.1016/j.jmig.2013.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 11/22/2013] [Accepted: 11/26/2013] [Indexed: 11/20/2022]
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Garza-Leal JG, León IH, Toub D. Pregnancy after transcervical radiofrequency ablation guided by intrauterine sonography: case report. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-013-0830-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Marcos RG, Monleón J, Martínez-Varea A, Gómez F, Montoliú G, Martínez JJ, Martí-Bonmatí L, Pellicer A. Percutaneous Ultrasound-Guided Radiofrequency Thermal Ablation for Treatment of Uterine Fibroids. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojog.2014.412100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Frederick S, Frederick J, Fletcher H, Reid M, Hardie M, Gardner W. A trial comparing the use of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone to decrease myometrial bleeding at the time of abdominal myomectomy. Fertil Steril 2013; 100:1044-9. [DOI: 10.1016/j.fertnstert.2013.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
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Ouldamer L, De Jesus I. [Myomas management, alternatives to hysterectomy and myomectomy: what can we propose?]. Presse Med 2013; 42:1113-6. [PMID: 23618627 DOI: 10.1016/j.lpm.2013.02.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/22/2013] [Indexed: 11/16/2022] Open
Abstract
Second generation endometrial ablation techniques must be used preferably as they present less complications than first generation techniques. An efficient contraception is highly recommended after thermal ablation. Myolysis techniques are still investigational, focused ultrasound myolysis MR or ultrasound-guided is accessible to approximately 10% of uterine myomas with 70% of long-term symptom relief. Outcomes of laparoscopic uterine artery occlusion are similar to those of uterine artery embolization but with less long-term durability.
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Affiliation(s)
- Lobna Ouldamer
- Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, département de gynécologie, 37044 Tours, France.
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Review of nonsurgical/minimally invasive treatments for uterine fibroids. Curr Opin Obstet Gynecol 2012; 24:368-75. [DOI: 10.1097/gco.0b013e328359f10a] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iversen H, Lenz S, Dueholm M. Ultrasound-guided radiofrequency ablation of symptomatic uterine fibroids: short-term evaluation of effect of treatment on quality of life and symptom severity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:445-451. [PMID: 22378629 DOI: 10.1002/uog.11118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid. METHODS Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded. RESULTS Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred. CONCLUSION USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.
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Affiliation(s)
- H Iversen
- Gynecologic Department, Naestved Hospital, University of Copenhagen, Naestved, Denmark.
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Fawzy M, Zayed A. Repeat Laparotomy After Abdominal Hysterectomy. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Muhammad Fawzy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
- Obstetrics and Gynecology Department, Mansoura University Hospital, Mansoura, Dakahlia, Egypt
| | - Abdelhady Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt
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Ouldamer L, Marret H. Alternatives thérapeutiques des fibromes hors traitement médicamenteux et embolisation. ACTA ACUST UNITED AC 2011; 40:928-36. [DOI: 10.1016/j.jgyn.2011.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Radiofrequency ablation for treatment of symptomatic uterine fibroids. Obstet Gynecol Int 2011; 2012:194839. [PMID: 21961009 PMCID: PMC3180825 DOI: 10.1155/2012/194839] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 07/21/2011] [Indexed: 11/30/2022] Open
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.
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