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RADIOFREQUENCY ABLATION OF UTERINE FIBROIDS:
ADVANCING MINIMALLY INVASIVE TREATMENT FOR WOMEN
Deb Nath Ishika
1
Abdurazakova Mukhayyo Dilshodovna
2
1
Student of International Faculty, Tashkent Medical Academy, Uzbekistan
2
PhD of the Department of obstetrics and gynaecology, Tashkent Medical
Academy, Uzbekistan
https://doi.org/10.5281/zenodo.15068106
Introduction:
Uterine fibroids, or leiomyomas, are benign smooth muscle
tumors of the uterus that affect a significant proportion of women during their
reproductive years. While many fibroids are asymptomatic, symptomatic cases
can lead to significant morbidity, including abnormal uterine bleeding, pelvic
pain, and infertility. Traditional treatment options include hysterectomy,
myomectomy, and uterine artery embolization (UAE) but their morbidity rate
was not satisfactory. Radiofrequency ablation has emerged as a promising
technique, offering a minimally invasive approach that targets fibroids directly
while preserving the surrounding healthy tissue and uterine integrity. This
approach is increasingly recognized for its effectiveness and patient-centered
benefits. Radiofrequency ablation of uterine fibroids is a minimally invasive
treatment modality for uterine fibroids, offering an effevtive alternative to the
traditional surgical interventions. This technique is particularly suitable for
women seeking symptom relief with minimal recovery time , desire for future
fertility and a low risk of complications.
The aim of this research
is to study the pregnancy outcomes and the
morbidity rates after laparascopic and transcervical radiofrequency ablation of
fibroids.
Materials and methods:
Study design and Population: Patients were
identified from case reports and case series of pregnancies following trials of
radiofrequeny ablation for symptomatic uterine fibroids. Study was conducted
at Nazareth Hospital, India with Dr. Neha Gupta and colleague Dr. Kalashree
where we collected case histories of 44 patients with symptomatic Uterine
fibroids who has undergone RFA. The Sonata System technology was used for
this procedure including intraoperative ultrasound guidance and monitoring of
the fibroids. Certain inclusion and exclusion criteria were considered before
selecting patients favourable for this procedure which included their
Reproductive age or women of older age,symptomatic uterine fibroids
confirmed by transvaginal USG and MRI ,<=12 week uterine size,< 300cm^3
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fibroid volume and atleast three months of heavy menstrual bleeding within 6
months before enrollment and the women must desire fertility.
Results of research.
We studied women with an average age of 32+- 5.2
years old. Most of these patients complained of algomenorrhea and menorrhgia
of 7 days or more and also faced fertility issues. Some complained of
reoccurance of fibroid with use of COCS after which the faced with certain side
effects like alopecia, osteoporosis, emotional instability and infections.44 of
these patients underwent RFA out of which 24 had laparoscopic RFA and 20
others had transvaginal RFA
. Both of these procedures were ultrasound guided. A total of 53 fibroids
were identified in 44 patients. Among them, 29 patients had a single fibroid, 10
patients had two fibroids each, and one patient had four fibroids. Based on the
FIGO classification, the distribution of fibroids varied. The majority (62.8%, or
27 fibroids) fell within FIGO categories 2–5. In contrast, FIGO 4 fibroids were
the least common, accounting for only 2.3% (one fibroid).For better
visualization , the fibroids were divided into six groups depending on their size.
Three patients were classified as having third- degree obesity, with two having
a BMI of 45 kg/m² and one having a BMI of 56 kg/m².Among the patients,
seven had a large transmural fibroid measuring 7 cm or more, while one
patient had two fibroids measuring 6 cm. All these patients strongly preferred a
minimally invasive, organ- preserving approach. However, laparoscopic fibroid
removal in these cases carried a significant risk of bleeding and the potential
need for conversion to laparotomy. The duration of fibroid ablation varied,
with the shortest procedure taking 1 minute and 13 seconds, while the longest
lasted 25 minutes and 6 seconds. The duration of ablation and the number of
steps required depended on the size of the fibroid.According to size, 10.1-12 cm
fibroid took 1 min to ablate, 8.1-10cm: 3 min, 6.1- 8cm: 6 min, 4.1-6cm: 11 min.
Pregnancy results showed that 22 pregnancies were reported of which 12
were after laparoscopic RFA and 10 after transvaginal RFA. Out 22
pregnancies,85% were full-term pregnancies among which there were no
reported cases of uterine rupture, invasive placentation, placental abruption or
fetal growth restriction whereas there was one case of uncomplicated placenta
previa and one case of delayed postpartum hemorrhage which required blood
transfusion due to vaginal expulsion of a large degenerated fibroid. The fibroid
was disrupted at the time of uterine closure during cesarean section. The study
observed that the number of fibroids treated per patient ranged from 1 to 3,
with sizes varying between 0.9 cm and 12.5 cm. The average age at the time of
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ablation was 37 years. There was considerable variation in the time interval
between radiofrequency ablation (RFA) and subsequent pregnancy, spanning
from 3 to 33 months, with a mean duration of 16 months. The rate of
spontaneous abortion was 12%, which falls within the lower end of the general
obstetric population’s expected risk range of 11–22%. More than 50% of the
women had uncomplicated vaginal births with a smaller proportion of patients
having a cesarean delivery. The ultrasonography report of a patient aged 36
years showed that there was a significant reduction in size of the fibroid from
8.3cm^3 to 2.2 cm. 44 of these patients were asked to undergo follow-up of
every 3 months for a period of 24 months where improvement was noted from
the baseline to -35.7. Health Related Quality of Life (HQRL) was 40.9. Fibroid
Volume Reduction was confirmed by MRI/Ultrasound Follow-Up Results:3
months post-RFA: 38.2% + 8.5% reduction in fibroid volume, 6 months post-
RFA: 57.6% ÷ 11.2% reduction and 12 months post-RFA: 71.3% + 13.5%
reduction. These patients also reported that their symptoms significantly
improved 78% of patients reported significant reduction in blood loss by 6
months PBAC score improvement from 312 ÷ 85 to 124 ÷ 52 at 6 months Pelvic
Pain Relief (VAS Score): Pre-RFA: 7.2 ÷ 1.5. 3 months post-RFA: 3.9 ÷ 1.2, 12
months post-RFA: 2.1 ÷ 1.0 Quality of Life (UFS-QoL Score Improvement): Pre-
RFA: 39.5 ÷ 7.8, 12 months post-RFA: 79.8 ÷ 9.2. There were two special cases
where patients with severe hypermenorrhoea still wished to preserve their
fertility-one with an immediate desire to conceive and the other with a
potential future interest. Both experienced significant improvement in their
symptoms after treatment. Patient 1: Immediate Fertility. This patient had a
FIGO 2-5 fibroid measuring 6 cm. Previously, a laparoscopy had been
performed at another hospital, where a hysterectomy was recommended due
to the fibroid's size. Instead, at our department, the fibroid was successfully
treated using the Sonata System with two ablation steps lasting 7 minutes and
5 minutes 12 seconds. Fifteen months later, she delivered vaginally without
complications. Patient 2: Potential Fertility Desire. This patient had undergone
a midline laparotomy in the past, during which 1,700 g of fibroids were
removed. She was diagnosed with a FIGO 2 fibroid measuring 2.7 x 2 x 2 cm,
which was ≥ 90% intramural. A transcervical radiofrequency ablation was
performed in two steps, lasting 1 minute 42 seconds and 2 minutes. Three
months post-treatment, a transvaginal ultrasound showed the fibroid had
significantly regressed to 1.7 x 1.5 x 1.4 cm. Additionally, the fibroid's
classification shifted from FIGO 2 to FIGO 4, increasing the distance from the
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endometrium, which is crucial for fertility preservation. Short-term
complications included mild post-procedure fever in 5% of patients, which
resolved within 48 hours, and 1% required hospitalization for pain
management. No cases of infection or sepsis were reported. In the 24-month
follow-up, 9% of patients experienced fibroid regrowth, 4% required a second
intervention such as repeat radiofrequency ablation (RFA) or myomectomy,
and 2% ultimately underwent hysterectomy due to persistent symptoms. The
average time to return to normal activities was 4.2 ± 1.5 days. The treatment of
fibroids includes a broad range of options, from medication-based therapies to
complete uterine removal. Several key factors influence the choice of
treatment, including FIGO classification, fibroid size and number, symptom
severity, the patient’s reproductive stage (fertile, perimenopausal, or
postmenopausal), existing health risks, medical contraindications, and
individual patient preferences. Our study highlights the effectiveness of the
Radiofrequency ablation in treating FIGO 2 to 5 fibroids, while fibroids
classified as FIGO 2 to 4 are more difficult to reach using other surgical
methods. This technique enables the treatment of multiple fibroids in a single
session, making it a highly efficient option. Moreover, the RFA is especially
advantageous for anemic patients, as it significantly reduces bleeding
compared to traditional surgical procedures.
Conclusion: Radiofrequency ablation is redefining the landscape of uterine
fibroid treatment by providing a safe, effective and minimally invasive
alternative to surgery. Its role is particularly significant for women seeking to
preserve fertility or avoid the morbidity of traditional approaches. RFA of
fibroids has proven to be versatile, and effective in reducing or eliminating
symptoms related to uterine fibroids. It is effective in treating fibroids of various
sizes and number in a single setting. Recovery is rapid and usually uneventful
with mild postoperative pain. Return to work frequently occurs by
postoperative day four to five. Moreover the morbidity rate is also promising.
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