Journal of Minimally Invasive Gynecology
This video describes the technique and advantages of laparoscopic radiofrequency ablation with ultrasound guidance for the treatment of very large multi-fibroid uteri.
Large tertiary care hospital.
Patients or Participants
45-year-old gravida 2 para 0 female with menorrhagia, dysmenorrhea, and bulk symptoms secondary to a very large multi-fibroid uterus. She desired a minimally invasive and uterine conserving method to treat her symptoms.
We performed laparoscopic radiofrequency ablation under ultrasound guidance for the patients’ multiple fibroids. The uterus was mapped ultrasonographically using the laparoscopic ultrasound transducer. Next, under laparoscopic visualization, the needle handpiece was inserted into the abdomen three centimeters away from the ultrasound transducer insertion point. With careful coordination between visualization on the ultrasound and the laparoscope, the handpiece was directed into specific myomas for ablation with deployment of the needle arrays. This allowed emission of radiofrequency energy to shrink the myoma tissue. The exact depth and total ablation time is calculated for each deployment prior to initiation of the ablation. It is important to note that larger myomas may require multiple overlapping treatments due to their size and density. The procedure was performed in an outpatient setting with an estimated blood loss of less than 10 milliliters.
Measurements and Main Results
Laparoscopic radiofrequency ablation for very large multi-fibroid uteri can be successfully performed under ultrasound guidance as a uterine conserving method to treat symptomatic fibroids. The technique has many advantages when compared to other surgical techniques used to treat fibroids, including minimal blood loss, decreased post-operative pain, shorter recovery time, and a potentially narrower learning curve given that advanced laparoscopic suturing skills are not required.
Shah AA, Fisher JE. Ultrasound Guided Laparoscopic Radiofrequency Ablation for Very Large Multi-Fibroid Uterus. 2020 Nov;27(7):S59–60. Available from: https://www-clinicalkey-com.beaumont1.proxy.liblynxgateway.com/#!/content/journal/1-s2.0-S1553465020308074