Laparoscopic radiofrequency ablation (RFA) of uterine leiomyomas improves pregnancy outcomes, according to a recent study presented by Antoinette Allen, MD, MAS, at the 2024 ACOG Clinical and Scientific Meeting.1
Takeaways
- Laparoscopic radiofrequency ablation (RFA) significantly enhances pregnancy outcomes for women with uterine fibroids compared to myomectomy.
- Women who underwent laparoscopic RFA had lower cesarean section rates (54.5%) compared to those who had myomectomy (100%).
- Uterine fibroids impose a substantial financial burden and negatively affect patients' quality of life and reproductive health, particularly among Black women.
- Laparoscopic RFA offers multiple benefits, including fast recovery, minimal severe adverse events, and reduced need for additional surgical interventions such as myomectomy.
- Miscarriage rates were similar between the laparoscopic RFA (40.9%) and myomectomy (42.9%) groups, although both were higher than general population rates.
Fibroids are the most common gynecologic tumor reported in pre-menopausal women. The annual cost of fibroids is $4.1 billion, which is higher than the annual cost of breast cancer. Additionally, fibroids lead to a $34 billion cost in lost work and direct medical costs.
Alongside the financial burden, fibroids have a significant adverse impact on patients’ quality of life and reproductive health. Black women are disproportionately impacted, including a reduced decline in growth rates with age.
During RFA, ultrasound is used to identify fibroids, and a radiofrequency (RF) probe is placed at a 3 mm incision. Afterward, monopolar RF energy is delivered to fibroids, with the tissues heated to 100 degrees Celsius leading to coagulative necrosis. This causes the fibroid cells to be reabsorbed.
Laparoscopic RFA has multiple benefits, including fast recovery time, reduced learning curve, improved clinical outcomes, and minimal severe adverse events. The procedure also reduces the odds of requiring myomectomy and cesarean section. However, there is little evidence about laparoscopic RFA during pregnancy.
Investigators conducted a prospective multicenter observational cohort study to compare pregnancy outcomes after laparoscopic RFA vs myomectomy. Participants included premenopausal women aged over 21 years with symptomatic uterine fibroids. Those with hysteroscopic myomectomy were excluded from the analysis.
This study was the first to directly compare pregnancy outcomes between laparoscopic RFA and myomectomy, and included a racially and ethnically diverse cohort. However, it was limited by a small sample size.
Laparoscopic RFA and myomectomy were the primary interventions, with 20 patients receiving laparoscopic RFA and 17 receiving myomectomy. Live birth was reported in 11 participants receiving laparoscopic RFA and 12 receiving myomectomy.
A significant difference in body mass index was reported between groups, at 31.76±9.89 in the laparoscopic RFA group vs 25.76±4.0 in the myomectomy group. Parity also significantly differed between groups, with a median parity of 1 reported in the laparoscopic RFS group vs 0 in the myomectomy group.
While both groups had a median number of 2 fibroids, the fibroid volume was 203±200 in the laparoscopic RFA group and 516±568 in the myomectomy group. Total follow-up time was 2.74 years and 2.15 years in these groups, respectively.
Miscarriage rates were also similar between groups, at 40.9% and 42.9%, respectively. This was higher than literature reported rates of miscarriage in the general population. Notably, cesarean section was performed in all participants of the myomectomy group, vs 54.5% of the laparoscopic RFA group.
Hysterectomy has commonly been indicated as an effective treatment against uterine fibroids.2 A recent study found improved outcomes following hysterectomy among patients enrolled in the Comparing Options for Management: Patient-Centered Results for Uterine Fibroids registry.
Improved outcomes included Uterine Fibroid Symptom and Quality of Life symptom severity scores, indicating the efficacy to hysterectomy. However, laparoscopic RFA has shown promise as a less invasive treatment option to improve outcomes among patients with uterine fibroids.
References
- Allen A. Pregnancy outcome after laparoscopic radiofrequency ablation of uterine leiomyomas. Presented at: The American College of Obstetricians and Gynecologists 2024 Annual Clinical & Scientific Meeting. San Francisco, CA. May 17-19, 2024.
- Krewson C. Hysterectomy improves uterine fibroid symptoms. Contemporary OB/GYN. September 7, 2023. Accessed May 17, 2024. https://www.contemporaryobgyn.net/view/hysterectomy-improves-uterine-fibroid-symptoms
