Laparoscopic radiofrequency thermal ablation safe and effective for fibroids


NEW YORK (Reuters Health), Mar 15 - Laparoscopic radiofrequency (RF) thermal ablation reduces the symptoms and volume of uterine myomas, at least in the short term, according to a report from Italy. "It must be emphasized that our study is a pilot study with a limited number of cases," Dr. Fabio Ghezzi cautioned. "RF thermal ablation cannot be proposed as a revolutionary treatment without the appropriate scientific validation."

P>"An increasing number of methods for endometrial ablation have been proposed in the last decade in patients with abnormal uterine bleeding," Dr. Ghezzi, from University of Insubria, Varese, told Reuters Health. "Similarly, RF thermal ablation could be proposed in cases of symptomatic isolated myomas, especially in premenopausal women."

As reported in the March American Journal of Obstetrics and Gynecology, Dr. Ghezzi and colleagues evaluated the feasibility and efficacy of laparoscopic RF ablation of uterine fibroids in 18 women with symptomatic intramural uterine myomas ranging in size from 3 to 8.6 cm in diameter and from 14.8 to 332.8 cubic centimeters in volume.

Seven (38.9%) of the dominant fibroids were treated with a single pass, the authors report, and the operative time ranged from 20 to 40 minutes.

There were no intraoperative or postoperative complications, the report indicates, and the procedure was associated with the absence of blood loss in all cases.

Median symptom scores fell from 43.7 at baseline to 20.3 at 3 months, with a further decline to 0 in the nine women seen 12 months after ablation, the researchers note. Median quality of life scores increased from 66.7 at baseline to 82.7 at 3 months and 100 at 12 months.

Myoma size declined by an average 41.5% at the 1-month follow-up visit and by 59% at the 3-month visit, the investigators report. Size did not change significantly at subsequent visits.

"Since the studies and the number of patients treated are limited, I would suggest treating only women who do not want pregnancies, with no more then three myomas of less than 8 cm," Dr. Ghezzi advised. "The patients must be informed that the experience is limited."

The advantage of the technique "is that the procedure is fast, not painful, the patient can be discharged after a few hours, and, above all, it leaves open all the other conventional options (myomectomy, hysterectomy, endometrial ablation, etc.)," Dr. Ghezzi added.

By Will Boggs, MD

Last Updated: 2005-03-15 10:20:27 -0400 (Reuters Health)

Am J Obstet Gynecol 2005;192:768-773.

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