Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study

Abstract

Purpose: The purpose of this study was to assess the feasibility and outcome of transvaginal ultrasound (US)-guided radiofrequency ablation of uterine fibroids assisted by a real-time virtual needle tracking (VT) system. Methods: Between January 2017 and February 2018, 19 patients (age 45 ± 8 y, range 36-53 y) with 25 symptomatic uterine fibroids underwent transvaginal radiofrequency ablation (RFA) at a single center. Mean number of fibroids for patient was 1.7 (min, max: 1-3). Patients with more than one fibroid were 10 (52.6%). Uterine fibroids (mean volume: 13.6 mL; range: 5.3-41.9 mL) were treated with a dedicated internally cooled 17 G 35 cm RF needle with 1 cm or variable active tip and the moving shot technique. An electromagnetic system was used for showing a virtual needle during the procedure. Contrastenhanced ultrasound evaluation was performed before and immediately at the end of procedure. Feasibility of the procedure, technical success rate, volume percentage reduction at 1, 3 and 6 months, clinical outcome (QOL score) and complications were analyzed. Results: Procedure was feasible in 19/19 patients (100%). Technical success was achieved in 100% of 25 treated fibroids. Mean fibroids volume decreased from 13.6 ml at baseline to 5.9 ml at 6 month (reduction rate 62.7%, range 48.5-76.9; p < .05). No major immediate or late complications occurred. Minor complications occurred in two patients. QOL score significantly improved from 68 ± 36 at baseline to 97 ± 16 at six-months follow-up (p < .05). Conclusion: Transvaginal US-guided RFA assisted by a real-time VT system is a feasible, safe and effective technique for the treatment of uterine fibroids. ARTICLE HISTORY

Clinical Performance of Radiofrequency Ablation for Treatment of Uterine Fibroids: Systematic Review and Meta-Analysis of Prospective Studies

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A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas

“…More specifically, this system is able to guarantee an in-plane approach by displaying a green line on the B-mode when the axis of the electrode fully matches the US scan plane with the projection of the active tip marked as a square, which becomes smaller as the RF electrode approaches the image plane. From that moment onwards, the path of the RF electrode is represented by a dashed line, the prospective RF electrode path is represented by a dotted line and its active tip is located with a green V [21] (Figure 2). Once the safest path to the target fibroid was identified both via ultrasound (TV or TA) and optically (L-RFMs and H-RFMs), the electrode was appropriately placed into the target fibroid under US real-time guidance and VT [21].…”

“…From that moment onwards, the path of the RF electrode is represented by a dashed line, the prospective RF electrode path is represented by a dotted line and its active tip is located with a green V [21] (Figure 2). Once the safest path to the target fibroid was identified both via ultrasound (TV or TA) and optically (L-RFMs and H-RFMs), the electrode was appropriately placed into the target fibroid under US real-time guidance and VT [21]. Ablation was performed with the ''moving shot and stepping Once the safest path to the target fibroid was identified both via ultrasound (TV or TA) and optically (L-RFMs and H-RFMs), the electrode was appropriately placed into the target fibroid under US real-time guidance and VT [21].…”

“…Once the safest path to the target fibroid was identified both via ultrasound (TV or TA) and optically (L-RFMs and H-RFMs), the electrode was appropriately placed into the target fibroid under US real-time guidance and VT [21]. Ablation was performed with the ''moving shot and stepping Once the safest path to the target fibroid was identified both via ultrasound (TV or TA) and optically (L-RFMs and H-RFMs), the electrode was appropriately placed into the target fibroid under US real-time guidance and VT [21]. Ablation was performed with the "moving shot and stepping shot" technique [22], whereby the RF electrode was inserted in the distal part of the fibroid and then moved backward in steps of 5-10 s. The RF generator operated at 480 kHz with a maximum power of 200 W and at a temperature ranging from 40 to 99 • C [23].…”

Application of oxytocin in ultrasound-guided percutaneous microwave ablation for treatment of hypervascular uterine fibroids: a preliminary report

“…Ultrasound-guided percutaneous MWA is an easy and fast procedure [10] that in recent years has been used to treat uterine fibroids and adenomyosis. Reports are that, for uterine fibroids, the percent volume of the non-enhanced field in the lesion after ablation relative to the volume before ablation (i.e., the ablation rate) ranges from 64.9 to 100% [11,12]. However, all these investigations focused on the changes in the fibroid volume, whereas the ablation effect on blood supply of the fibroid was not addressed.…”