Radiofrequency Ablation of Leiomyomas via a Single-Site Incision

TL;DR

This paper presents a new surgical technique using single-site radiofrequency ablation to treat uterine fibroids, offering benefits like less scarring and faster recovery.

Contribution

The novelty lies in demonstrating the feasibility of single-site laparoscopic radiofrequency ablation for treating uterine leiomyomas.

Findings

Single-site RFA successfully treated both anterior and posterior myomas with minimal blood loss and rapid recovery.

The technique resulted in less incisional pain, less scarring, and better cosmesis compared to traditional multi-port approaches.

The patient was discharged the same day and resumed daily activities quickly.

Abstract

Laparoscopic radiofrequency ablation (RFA) is a minimally-invasive technique to decrease the size of tumors using thermal energy to destroy tissue. Uterine leiomyomas are common conditions comprising benign smooth muscle tumors. Single-incision laparoscopic surgery is a modern surgical approach for allowing the removal of diseased organs through a small skin incision. We aim to demonstrate the feasibility and advantages of a single-site RFA for uterine leiomyomas, highlighting its potential to reduce operative time, minimize scarring, and improve patient recovery compared to traditional multi-port approaches. We present the case of a 46-year-old female patient who presented for scheduled RFA of a dominant 4.5 cm anterior myoma causing heavy menstrual bleeding. A uterine manipulator was introduced into the endometrial cavity. A single-site port was introduced into the abdomen and laparoscopic ultrasound was then performed revealing a 4.5 cm anterior myoma as well as a posterior myoma The anterior aspect of the fibroid was desiccated using an RFA probe set at 95°C for two minutes. The probe was then repositioned to the posterior aspect and desiccated in multiple locations until complete treatment was achieved. This case demonstrates the successful treatment of a 4.5 cm anterior uterine myoma and posterior fibroid using single-site RFA, resulting in minimal blood loss, reduced postoperative pain, and rapid recovery. The surgery was performed in a manner identical to traditional laparoscopic RFA with three ports. In addition to minimal blood loss, our single-site approach resulted in less incisional pain, less scarring, and better cosmesis. The patient was discharged on the same day and rapidly resumed her activities of daily living as assessed during her postoperative visit. Our case highlights the benefits of novelty in medicine with increased patient satisfaction regarding cosmesis. This technique has the potential to reduce costs by reducing operative time and facilitating a faster return to work for the patient. With appropriately selected patients, similar access to most myomas can be achieved.

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