Major complications and surgical reintervention after ultrasound-guided transcervical radiofrequency ablation of uterine fibroids: a 10-year experience
Abstract
Objectives
To evaluate the incidence of and risk factors for major complications and surgical reintervention following transcervical ultrasound-guided radiofrequency ablation (RFA) of uterine fibroids.
Methods
In this retrospective study, 1290 patients with 1358 symptomatic uterine fibroids underwent outpatient transcervical ultrasound-guided RFA between July 2009 and July 2021. Medical records were reviewed to assess major complications and surgical reintervention rates.
Results
The overall incidence of major complications was 5.1% (66/1290), including intestinal perforation (n = 1, 0.08%), infection (n = 39, 3.0%), intrauterine adhesions (n = 24, 1.9%), and deep venous thrombosis (n = 2, 0.15%). The 10-year cumulative surgical reintervention rate was 8.5%. Indications for reintervention included persistent fibroid-related symptoms (n = 65, 5.0%), fibroid recurrence (n = 35, 2.7%), intracavitary free myoma (n = 9, 0.7%), and malignant uterine mesenchymal neoplasia (n = 1, 0.08%). Multivariate analysis identified increased puncture frequency as a risk factor for postoperative infection (OR = 3.32, 95% CI: 1.02–10.7; P = 0.046).
Conclusions
Transcervical ultrasound-guided RFA is a well-tolerated outpatient procedure with an acceptably low rate of major complications and surgical reintervention for treatment of uterine fibroids.
Advances in knowledge
More punctures may contribute to higher infection rate. There is a need to keep all the uterine fibroids in check after RFA since malignant neoplasia may occur over a period.