Comparison of Laparoscopic Radiofrequency Myolysis (LRFM) and Ultrasonographic Radiofrequency Myolysis (URFM) in Treatment of Midline Dysmenorrhea

OBJECTIVES: To access the effectiveness of radiofrequency myolysis (RFM) in women with midline dysmenorrhea. METHODS: We designed RFM in two ways laparoscopic RFM (LRFM), vaginal ultrasound-guided RFM (URFM). One hundred and thirty-two patients were in the LRFM group and, 140 patients were in the URFM group. RESULTS: Upon receipt of surgery, both the LRFM and the URFM groups demonstrated a significant decrease (P < 0.001) in the mean pain score when compared to those before and after surgery. CONCLUSION: The RF uterine myolysis procedure provides an alternative for those patients who suffer from intractable midline dysmenorrhea. LRFM is an alternative choice because it is relatively safe and, simple to perform and moreover, it is satisfactory. LRFM appears to increasingly succeed in the treatment of midline dysmenorrhea.

The comparison of clinical features of minilaparoscopic radiofrequency myolysis with laparoscopic-assisted vaginal hysterectomy in the treatment of uterine myoma / 대한산부인과학회지

OBJECTIVE: To compare clinical features of minilaparoscopic radiofrequency myolysis (MLRFM) with laparoscopic-assisted vaginal hysterectomy (LAVH) in the treatment of uterine myoma. METHODS: Between 1st January 2006 and 31th March 2009, 125 patients underwent LAVH and 125 patients underwent MLRFM by same surgeon at the University of Chosun Hospital, Department of Gynecology. We compared the age of patients, indication for treatment, myoma size, major symptom, duration of procedure, amounts of blood loss and postoperative transfusion, length of hospital day, postoperative complication and satisfaction between the two groups. RESULTS: There were significant differences in duration of procedure between the LAVH group and the MLRFM group (69.0+/-31.6 minutes vs 43.5+/-19.8 minutes) and in the amounts of blood loss during procedure (215.2+/-215.0 mL vs 0.8+/-8.9 mL). The amounts of postoperative transfusion was 0.3+/-0.7 pints, 16 of the 125 (12.8%) for the LAVH group and no one underwent postoperative transfusion for the MLRFM group. There was significant difference in length of postoperative hospital day between the LAVH group and the MLRFM group (5.0+/-1.2 days vs 2.3+/-1.2 days). In the comparison of postoperative complications, there was no significant complication for the LAVH group, but there was major complications requiring readmission and reoperation for the MLRFM group. In MLRFM group, postoperative myoma size decreased compared to preoperative size. CONCLUSION: We conclude that there was no treatment of choice in uterine myoma. When considering treatment of uterine myoma, we should choose appropriate method after analyzing patient characteristics, general condition, uterine myoma characteristics case by case.

A case of normal spontaneous vaginal delivery after transvaginal radiofrequency myolysis / 대한주산의학회잡지

Radiofrequency myolysis does not require general anesthesia and is safe and effective treatment for uterine myomas tried to women in women who wish to conserve the uterus. However, a controversial issue is whether radiofrequency myolysis is safe to women who desire future pregnancies. We report a case who experienced full term spontaneous vaginal delivery without uterine rupture after radiofrequency myolysis.

A case of full term normal spontaneous vaginal delivery after radiofrequency myolysis / 대한산부인과학회지

Radiofrequency (RF) myolysis is a minimally invasive treatment by create thermal energy in targeted uterine fibroid and cause the aseptic necrosis of leiomyoma cells. Unlike hysterectomy which is considered to be the most common treatment of uterine leiomyoma, RF myolysis can preserve the uterus, and unlike myomectomy which can preserve the uterus but requires the hospitalization and general anesthesia, it can be performed as outpatient procedure using only sedation for pain relief without additional need for medication. There are many published studies reporting the pregnancy complications and outcomes after myomectomy, but few studies regarding pregnancy and myolysis are available. We have experienced a full term vaginal delivery after RF myolysis of subserosal myoma and hereby we report our case with a brief review.

The 1-year follow-up results of radiofrequency myolysis on uterine myomas / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical results of radiofrequency (RF) myolysis on uterine myomas for 1 year after the procedure. METHODS: 56 women with symptomatic uterine myomas underwent RF myolysis at Chosun University hospital between January 2006 and December 2006. The study group designed by 22 women who were followed up for 1 year after the procedure. Preoperatively, by using ultrasonography, size, numbers, location and volume of uterine myomas were checked and hemoglobin and subjective symptoms were checked. 3 months, 6 months, 9months and 12months after the procedure, the size and volume of uterine myomas were measured by same examiner. And also the symptoms caused by uterine myomas were observed. RESULTS: The average age of the patients was 43.0 years. The average maximal diameter of uterine myoma was 5.7+/-1.9 cm, the average volume was 83.2+/-67.6 cm3, and the average hemoglobin was 11.5+/-2.0 mg/dL. 3 months, 6 months, 9 months and 12 months after the procedure, the average maximal diameters of the uterine myomas were decresed by 4.7+/-1.8 cm, 4.4+/-1.6 cm, 4.3+/-1.7 cm, 3.9+/-1.6 cm and the average volume was decreased by 49.5+/-46.5 cm3, 41.1+/-43.2 cm3, 40.5+/-43.7 cm3, 30.8+/-34.6 cm3 respectively, and the average hemoglobin was 11.8+/-1.8 mg/dL, 11.9+/-1.8 mg/dL, 12.1+/-1.7 mg/dL, 12.1+/-1.5 mg/dL. After the procedure, 81.3%, 84.8%, 87.0%, 86.4% of the group had improvement of the symptoms (dysmenorrhea, hypermenorrhea, pelvic pain) respectively. CONCLUSION: RF myolysis had effects on reduction of the size of uterine myomas and improvement of the symptoms. RF myolysis would be a useful alternative treatment of uterine myomas with preserving the uterus.

Two cases of cesarean section after laparoscopic radiofrequency myolysis / 대한산부인과학회지

Radiofrequency myolysis is a method for preserving uterus and fecundity, and due to its more non-invasive and simpler operation, it is now carried out to cure the uterine myomas. However, not long time has passed since this operation started, and little studies were conducted on this complications and side effects. Therefore, since the authors experienced the pregnancy after radiofrequency myolysis of uterine myoma, we hereby report the cases.

Factors affecting the satisfaction rate of radiofrequency myolysis: 18 months follow up / 대한산부인과학회지

OBJECTIVE: To report 18 months follow up results of radiofrequency myolysis and analysis the factors which effect the success rate of myolysis. METHODS: 153 patients who took radiofrequency myolysis between October 2004.~June 2006 in this hospital were enrolled this retrospective study. Except 14 patients which had incomplete data, total 139 patient's charts were reviewed. Sonographic evaluations were checked after a week, 1 month, 3 months, 6 months, 12 months, and 18 months after myolysis. Questions about complications like vaginal bleeding, abdominal pain, feber and vaginal discharge were asked to patients in every visits. Volume of the myoma were checked via 3D ultrasonography. RESULTS: Reduction rate of the volume of myoma after 18 months were 73% and reoperation rate were 4.3%. Improvement rates of patients symptom were 87% (menorrhagea 95%, dysmenorrheal 75%, pelvic pain 60%) The patients who had myomas sized over 100 ml before treatments showed statistically higher rate of reoperation, and decreased rate of satisfaction. Reoperation rate and reduction rate of myoma showed no difference through pathologic diagnosis. The patients who had initial symptoms showed higher rate of satisfaction after myolysis. Total satisfaction rate were 62%, and no serious complications like bowel injury, bladder injury, sepsis and peritonitis were not reported. CONCLUSION: Satisfaction rate after radiofrequency myolysis was increased in symptomatic leiomyoma especially smaller than 6.5 cm in diameter.

Transvaginal radiofrequency myolysis for conservative management of uterine myomas / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of transvaginal radiofrequency myolysis of uterine myomas. METHODS: 67 women who had undergone transvaginal radiofrequency myolysis of uterine myomas at Eulji university hospital between May 2005 and March 2006 were participated in this study. Pre-procedural transabdominal and transvaginal ultrasonographic evaluation was done for measurement of the size, numbers, location, and volume of the myomas. 1 month, 3 months, and 6 months after the procedure the numbers and size of the myomas were measured by the same examiner. And also improvement of menorrhagia, dysmenorrhea, abnormal vaginal bleeding, and any symptoms like urinary frequency and pelvic pain that were caused by compression of the myomas were observed on every visit. RESULTS: The average age of the patients were 42.2 years. The average number of myomas were 1.18, the average of the maximal diameter was 5.52 cm, and the average volume was 89.9 cm3. The average procedure time was 15.1 minutes, and the average procedure frequency was 1.4 times. 1 month, 3 moths, and 6 months after the procedure the average maximal diameter of the myomas were decreased by 14.2%, 22.8%, and 29.8% respectively and the average volume decreased by 34.9%, 52.5%, and 63.6% respectively. 8 women who had no early symptoms and who were postmenopaused were excluded and from the other 59 women, 45 women and 37 women had been confirmed of their symptoms after 3 months and 6 months of the procedure respectively. 86.7%, 82.8% of the group had improvement of dysmenorrhea, and 65.2%, 60% had improvement of menorrhagia after 3 months and 6 months of procedure respectively. The group which had both symptoms, 85% and 81.2% had improvement. There were post-procedural complications of lower abdominal pain in 7 women, vaginal bleeding in 1 woman and in 1 case the patient was transferred to the department of internal medicine due to post-procedural fever and abdominal discomfort. No other major complications were found. CONCLUSION: Transvaginal radiofrequency myolysis had benefits in conserving the uterus, and was less invasive and had great effect on the reduction of size of the myomas and improving the symptoms. So this method could be a effective alternative treatment for uterine myomas.

Enlarged leiomyoma after myolysis with radiofrequency / 대한산부인과학회지

Radiofrequency myolysis is newly developed method for management of myoma. Patients do not need to under general anesthesia neither admission. It decrease the size of myoma with preserve uterus. But the complication and side effect of radiofrequency myolysis had not been published. We have experienced two cases of increased size of the myoma with secondary degeneration after myolysis, so report that with a brief review of literatures.