Transvaginal ultrasound- and laparoscopy-guided percutaneous microwave ablation for adenomyosis: preliminary results

Abstract

Purpose: Adenomyosis is a relatively common disease among women of childbearing age. A minimally invasive alternative technique with low risks, faster recovery and decreased side effects is desired. We hypothesized that percutaneous microwave ablation (PMWA) under laparoscopic guidance would substantially reduce the risk of collateral thermal damage to the intestinal tract and relieve the pelvic adhesions. This study aimed to evaluate the feasibility, safety and efficacy of transvaginal ultrasoundand laparoscopy-guided PMWA for the treatment of adenomyosis. Materials and methods: From May 2015 to October 2017, a total of 70 patients with symptomatic adenomyosis who underwent transvaginal ultrasound-and laparoscopy-guided PMWA were included in this study. The technical efficacy and complications of PMWA were assessed. Meanwhile, the uterine volume, lesion volume, symptom severity score (SSS) and visual analog scale (VAS) score before PMWA and at 1, 6 and 12 months after PMWA were recorded. Results: PMWA was successfully performed with transvaginal ultrasound guidance and laparoscope assistance in all patients. No major complication was found after PMWA in any patients. The uterine volume, lesion volume, SSS and VAS were all decreased significantly at follow-up (p < .01). Conclusion: Transvaginal ultrasound-and laparoscopy-guided PMWA, which significantly decreased the uterine volume, lesion volume, SSS and VAS score, is a feasible minimally invasive technique for the treatment of adenomyosis.

Ultrasound-guided percutaneous microwave ablation of adenomyosis: a narrative review

“…The uterine volume and nidus reduction rates are also important evaluation indexes for the effect of microwave ablation of adenomyosis. Liu et al (15) observed the uterine volume reduction rate after microwave ablation in 70 patients with adenomyosis; after 1, 6, and 12 months, the reduction rate was 28.2%, 50.6%, and 55.2%, respectively. In patients with adenomyosis, Lin et al (16) reported uterine volume reduction rates of 44.8% and 64.9% at 3 and 12 months after microwave therapy, respectively, which were better than those after radiofrequency ablation.…”

“…Subsequently, according to accurately positioned contrast-enhanced ultrasound, the ablation was supplemented immediately, and contrastenhanced ultrasound was performed again 1 to 2 days after the procedure; the ablation rates rose to 92%, 93%, and 95%, respectively. In their study, Xu et al (19)(20)(21)(22)(23) compared the difference in the microwave ablation effect between contrast-enhanced ultrasound and enhanced MRI, and found that contrast-enhanced ultrasound could be used to accurately evaluate the ablation rate of local adenomyosis following microwave ablation, with the consequence being consistent with that of enhanced MRI. Contrast-enhanced ultrasound is a simple, real-time, dynamic, and cost-effective method, which is more suitable for timely evaluation after microwave ablation.…”

“…Thirteen studies involving 736 patients who received ultrasound-guided microwave ablation for adenomyosis were retrieved (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). An ablation frequency of 2,450 MHz was adopted for all the microwave ablation instruments used in the included studies, and the power range was 40-120 W. The number of ablation needles was selected according to the size of the nidus.…”

Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis

“…Finally, 38 articles , met all inclusion criteria and were included in this meta-analysis. The types of ablation were HIFU in 28 studies , PMWA in five studies [46][47][48][49][50] and RFA in four studies [51][52][53][54]. Besides, one study [45] compared PMWA with RFA in the management of AD.…”

“…The incidence of minor adverse events was 39.0%, 51.3% and 3.6% after HIFU, PMWA and RFA, respectively. The main minor adverse events were transient sciatic nerve pain, transient unilateral leg weakness, transient hematuria, skin burn, vaginal bleeding and lower abdominal pain in the HIFU group [19][20][21]24,26,28,[35][36][37], and transient macroscopic hematuria, vaginal discharge and lower abdominal pain in the PMWA and RFA groups [46][47][48]51,52,54]. Although all cases were minor and recovered without any permanent adverse effects, these events revealed thermal injury to the surrounding tissues, such as the sciatic nerve, bladder, endometrium, bowel and abdominal skin.…”