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Semin intervent Radiol 2023; 40(04): 335-341
DOI: 10.1055/s-0043-1770734
Review Article

Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency Ablation

Caroline S. Kwon
1   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Noor Dasouki Abu-Alnadi
1   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Erratum zu diesem Artikel:

Erratum: Updates on the Surgical Approach to Fibroids: The Importance of Radiofrequency AblationSemin intervent Radiol 2023; 40(04): e1-e1
DOI: 10.1055/s-0043-1775803

Abstract

Uterine fibroids are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which can range from heavy menstrual bleeding and bulk-related symptoms such as pelvic pressure with bladder and bowel dysfunction to reproductive dysfunction (e.g., infertility or obstetric complications) and pain. The choice of treatment is primarily guided by the type of symptoms in the individual patient and whether they prefer to retain fertility. While hysterectomy provides definitive resolution of fibroid symptoms and remains the most common treatment option, this procedure is invasive with a long recovery window. Radiofrequency ablation (RFA) is now emerging as a uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, growing evidence for safety and efficacy of RFA has been generated with low rates of complications. This review will discuss RFA for the management of symptomatic uterine fibroids with a special focus on technical approaches, short- and long-term outcomes including fertility outcomes.

Keywords

fibroid - uterus - menorrhagia - radiofrequency ablation - fertility - surgery - interventional radiology


Publikationsverlauf

Artikel online veröffentlicht:
10. August 2023

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  • References

  • 1 Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188 (01) 100-107
    CrossrefPubMedGoogle Scholar
  • 2 Barbieri RL. New hormonal medical treatment is an important advance for AUB caused by uterine fibroids. OBGM 2020; 32 (08) DOI: 10.12788/obgm.0024.
    CrossrefPubMedGoogle Scholar
  • 3 Liao L, Chen L, Melamed A, Hershman DL, Wright JD. Use of conservative therapies before hysterectomy for uterine leiomyomas. Obstet Gynecol 2023; 141 (02) 371-374
    CrossrefPubMedGoogle Scholar
  • 4 Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol 2013; 209 (04) 319.e1-319.e20
    CrossrefPubMedGoogle Scholar
  • 5 Parker WH. Uterine fibroids (leiomyomas): abdominal myomectomy. In: Chakrabarti A. eds. UpToDate. Waltham, MA: ; February 14, 2020
    Google Scholar
  • 6 Bradley LD. Overview of hysteroscopy. In: Eckler K. ed. UpToDate. Waltham, MA: ; December 21, 2020
    Google Scholar
  • 7 Manyonda I, Belli AM, Lumsden MA. et al; FEMME Collaborative Group. Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med 2020; 383 (05) 440-451
    CrossrefPubMedGoogle Scholar
  • 8 Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine 2008; 33 (12) 1291-1297 , discussion 1298
    CrossrefPubMedGoogle Scholar
  • 9 Doukas G, Samani NJ, Alexiou C. et al. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA 2005; 294 (18) 2323-2329
    CrossrefPubMedGoogle Scholar
  • 10 Kim YS, Rhim H, Lim HK. et al. Intraoperative radiofrequency ablation for hepatocellular carcinoma: long-term results in a large series. Ann Surg Oncol 2008; 15 (07) 1862-1870
    CrossrefPubMedGoogle Scholar
  • 11 Varkarakis IM, Allaf ME, Inagaki T. et al. Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup. J Urol 2005; 174 (02) 456-460 , discussion 460
    CrossrefPubMedGoogle Scholar
  • 12 Lee BB. Radiofrequency ablation of uterine leiomyomata: a new minimally invasive hysterectomy alternative. Obstet Gynecol 2002; 99 (Suppl): 9S
    PubMedGoogle Scholar
  • 13 Hammerich D. Tissue ablation. In: Webster JG. ed. Wiley Encyclopedia of Medical Devices and Instrumentation. New Jersey: John Wiley & Sons; 2006: 362-379
    Google Scholar
  • 14 Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S179-S186
    CrossrefPubMedGoogle Scholar
  • 15 Kho K, Shepherd J, Sobolewski C. Panel 2-RF frequency ablation of uterine fibroids - the new frontier. Presented at AAGL's 50th Global Congress on MIGS; November 15, 2021; Austin, TX
    PubMedGoogle Scholar
  • 16 Goldberg SN, Gazelle GS, Halpern EF, Rittman WJ, Mueller PR, Rosenthal DI. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996; 3 (03) 212-218
    CrossrefPubMedGoogle Scholar
  • 17 Jacoby VL, Parvataneni R, Oberman E. et al. Laparoscopic radiofrequency ablation of uterine leiomyomas: clinical outcomes during early adoption into surgical practice. J Minim Invasive Gynecol 2020; 27 (04) 915-925
    CrossrefPubMedGoogle Scholar
  • 18 Acessa ProVu System user guide. Acessa. Accessed April 20, 2023 at: https://www.hologic.com/package-inserts/gyn-surgical-products/acessa-laparoscopic-radiofrequency-ablation
    PubMedGoogle Scholar
  • 19 Sonata System instructions for use, with technical appendix. Gynesonics. Accessed April 20, 2023 at: https://gynesonics.com/us/wp-content/uploads/sites/2/2021/03/LS-03818-009.A-REF-009-IFU-Sonata-2.2.pdf
    PubMedGoogle Scholar
  • 20 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 Obstet Gynecol 2012; 40 (04) 445-451
    CrossrefPubMedGoogle Scholar
  • 21 Yu S, Bhagavath B, Shobeiri SA, Eisenstein D, Levy B. Clinical and patient reported outcomes of pre- and postsurgical treatment of symptomatic uterine leiomyomas: a 12-month follow-up review of TRUST, a surgical randomized clinical trial comparing laparoscopic radiofrequency ablation and myomectomy. J Minim Invasive Gynecol 2022; 29 (06) 726-737
    CrossrefPubMedGoogle Scholar
  • 22 Chudnoff S, Guido R, Roy K, Levine D, Mihalov L, Garza-Leal JG. Ultrasound-guided transcervical ablation of uterine leiomyomas. Obstet Gynecol 2019; 133 (01) 13-22
    CrossrefPubMedGoogle Scholar
  • 23 Lin E, Sendukas E, Kho KA. Postoperative uterine necrosis and peritonitis following laparoscopic radiofrequency myoma ablation. J Minim Invasive Gynecol 2022; 29 (10) 1123-1124
    CrossrefPubMedGoogle Scholar
  • 24 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 (12) 1507-1517
    CrossrefPubMedGoogle Scholar
  • 25 Berman JM, Guido RS, Garza Leal JG, Pemueller RR, Whaley FS, Chudnoff SG. Halt Study Group. Three-year outcome of the Halt trial: a prospective analysis of radiofrequency volumetric thermal ablation of myomas. J Minim Invasive Gynecol 2014; 21 (05) 767-774
    CrossrefPubMedGoogle Scholar
  • 26 Lin L, Ma H, Wang J. et al. Quality of life, adverse events, and reintervention outcomes after laparoscopic radiofrequency ablation for symptomatic uterine fibroids: a meta-analysis. J Minim Invasive Gynecol 2019; 26 (03) 409-416
    CrossrefPubMedGoogle Scholar
  • 27 Davis MR, Soliman AM, Castelli-Haley J, Snabes MC, Surrey ES. Reintervention rates after myomectomy, endometrial ablation, and uterine artery embolization for patients with uterine fibroids. J Womens Health (Larchmt) 2018; 27 (10) 1204-1214
    CrossrefPubMedGoogle Scholar
  • 28 Chudnoff SG, Berman JM, Levine DJ, Harris M, Guido RS, Banks E. Outpatient procedure for the treatment and relief of symptomatic uterine myomas. Obstet Gynecol 2013; 121 (05) 1075-1082
    CrossrefPubMedGoogle Scholar
  • 29 Hudgens J, Johns DA, Lukes AS, Forstein DA, Delvadia D. 12-month outcomes of the US patient cohort in the SONATA pivotal IDE trial of transcervical ablation of uterine fibroids. Int J Womens Health 2019; 11: 387-394
    CrossrefPubMedGoogle Scholar
  • 30 Brölmann H, Bongers M, Garza-Leal JG. et al. The FAST-EU trial: 12-month clinical outcomes of women after intrauterine sonography-guided transcervical radiofrequency ablation of uterine fibroids. Gynecol Surg 2016; 13 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 31 Garza-Leal JG. Long-term clinical outcomes of transcervical radiofrequency ablation of uterine fibroids: the VITALITY Study. J Gynecol Surg 2019; 35 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 32 Lukes A, Green MA. Three-year results of the SONATA pivotal trial of transcervical fibroid ablation for symptomatic uterine myomata. J Gynecol Surg 2020; 36 (05) 228-233
    CrossrefPubMedGoogle Scholar
  • 33 Gingold JA, Gueye NA, Falcone T. Minimally invasive approaches to myoma management. J Minim Invasive Gynecol 2018; 25 (02) 237-250
    CrossrefPubMedGoogle Scholar
  • 34 Brucker SY, Hahn M, Kraemer D, Taran FA, Isaacson KB, Krämer B. Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy. Int J Gynaecol Obstet 2014; 125 (03) 261-265
    CrossrefPubMedGoogle Scholar
  • 35 Hahn M, Brucker S, Kraemer D. et al. Radiofrequency volumetric thermal ablation of fibroids and laparoscopic myomectomy: long-term follow-up from a randomized trial. Geburtshilfe Frauenheilkd 2015; 75 (05) 442-449
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 36 Brooks EA, Singer AM, Delvadia DR. et al. The CHOICES Study: facility level comparative cost, resource utilization, and outcomes analysis of myomectomy compared to transcervical fibroid ablation. Clinicoecon Outcomes Res 2020; 12: 299-306
    CrossrefPubMedGoogle Scholar
  • 37 Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol 2012; 206 (03) 211.e1-211.e9
    CrossrefPubMedGoogle Scholar
  • 38 Berman JM, Shashoua A, Olson C, Brucker S, Thiel JA, Bhagavath B. Case series of reproductive outcomes after laparoscopic radiofrequency ablation of symptomatic myomas. J Minim Invasive Gynecol 2020; 27 (03) 639-645
    CrossrefPubMedGoogle Scholar
  • 39 Claeys J, Hellendoorn I, Hamerlynck T, Bosteels J, Weyers S. The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. Gynecol Surg 2014; 11 (03) 197-206
    CrossrefPubMedGoogle Scholar
  • 40 Christoffel L, Bends R, Toub D. et al. Pregnancy outcomes after transcervical radiofrequency ablation of uterine fibroids with the Sonata system. J Gynecol Surg 2022; 38 (03) 207-213
    CrossrefPubMedGoogle Scholar
  • 41 Bongers M, Gupta J, Garza-Leal JG, Brown M, Felberbaum R. The INTEGRITY Trial: preservation of uterine-wall integrity 12 months after transcervical fibroid ablation with the Sonata system. J Gynecol Surg 2019; 35 (05) 299-303
    CrossrefPubMedGoogle Scholar
  • 42 Bongers M, Quinn SD, Mueller MD. et al. Evaluation of uterine patency following transcervical uterine fibroid ablation with the Sonata system (the OPEN clinical trial). Eur J Obstet Gynecol Reprod Biol 2019; 242: 122-125
    CrossrefPubMedGoogle Scholar
  • 43 Taskin O, Sadik S, Onoglu A. et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc 2000; 7 (03) 351-354
    CrossrefPubMedGoogle Scholar