Presented by:
Hanna Goldberg
Affiliations:
St. Michael’s Hospital
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What is Laparoscopic Radiofrequency Ablation?
Laparoscopic radiofrequency ablation (RFA) is a minimally invasive, uterine-sparing treatment for uterine fibroids. Rather than surgically removing the fibroids, radiofrequency energy is delivered directly into the fibroid tissue, causing controlled thermal damage that leads the fibroids to gradually shrink over time. Here’s what it involves:
- Patient Selection and Planning: Imaging is used to assess the number, size, location, and type of fibroids and determine whether laparoscopic RFA is an appropriate treatment option.
- Laparoscopic Access: Small abdominal incisions are made to introduce a laparoscope and other surgical instruments into the pelvis.
- Intraoperative Ultrasound: A laparoscopic ultrasound probe is used to identify individual fibroids, determine their dimensions, and guide accurate placement of the treatment device.
- Radiofrequency Probe Placement: A specialized needle or probe is inserted directly into the targeted fibroid under ultrasound guidance.
- Radiofrequency Energy Delivery: Controlled energy is delivered to heat and ablate the fibroid while limiting thermal exposure to surrounding healthy uterine tissue.
- Treatment of Additional Fibroids: The process can be repeated for multiple appropriate fibroids during the same procedure.
- Final Inspection: The uterus and surrounding structures are inspected for bleeding, thermal injury, or other complications before completing the surgery.
Unlike myomectomy, laparoscopic RFA treats fibroids without requiring their surgical removal, allowing the uterus to remain intact while treated fibroids gradually decrease in size.
What are the Risks of Laparoscopic Radiofrequency Ablation?
Although laparoscopic RFA avoids the larger uterine incisions associated with some other fibroid surgeries, it still carries risks related to laparoscopy and the delivery of thermal energy.
- Thermal Injury: Radiofrequency energy can potentially damage surrounding structures, including the bowel, bladder, blood vessels, or healthy uterine tissue.
- Bleeding: Injury to the uterus or nearby blood vessels during probe placement can cause bleeding, although significant hemorrhage is uncommon.
- Infection: Infection of the uterus, treated fibroid tissue, abdominal incisions, or pelvis can occur following treatment.
- Incomplete Symptom Relief: Fibroids may not shrink sufficiently to resolve symptoms, and additional treatment may eventually be required.
- New or Recurrent Fibroids: RFA treats targeted existing fibroids but does not prevent new fibroids from developing elsewhere in the uterus.
- Post-Ablation Symptoms: Cramping, pelvic discomfort, vaginal discharge, or temporary changes in bleeding may occur as treated fibroids undergo degeneration.
- Injury from Laparoscopic Access: Placement of laparoscopic instruments carries a small risk of injury to the bowel, bladder, blood vessels, or other abdominal structures.
- Future Pregnancy Considerations: Pregnancy after laparoscopic RFA is possible, but reproductive and obstetric outcomes are less extensively established than for some traditional treatments, making individualized counselling important.
- General Surgical Risks: Infection, blood clots, anesthesia-related complications, and rarely conversion to open surgery are possible.
Careful patient selection, intraoperative ultrasound guidance, precise probe placement, and controlled delivery of radiofrequency energy help minimize risks while preserving the uterus and surrounding healthy tissue.