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BackTable / OBGYN / Article
Transcervical Fibroid Ablation: Advancements in Uterine Fibroid Treatment
Olivia Reid • Updated Oct 4, 2024 • 263 hits
In the field of women’s health, there is a growing need for safer and more accessible treatment options for uterine fibroids, in order to both reduce invasiveness and broaden the scope of fibroid management to potentially decrease the reliance on hysterectomies. Doctors Barbara Levy, Mark Hoffman, and Amy Park present newer technologies, including radiofrequency ablation and transcervical ablation, as solutions to this clinical problem.
Radiofrequency ablation (RFA) presents a promising advancement in fibroid treatment due to its recorded successes and increased safety measures. Although RFA is a tried and true treatment modality, recent innovations have incorporated ultrasound guidance and machine learning algorithms to ensure precise energy delivery. Alongside RFA, the transcervical ablation technique emerges as a significant leap forward in minimally invasive fibroid management. Contrasting with laparoscopic approaches, transcervical ablation obviates incisions entirely, offering early intervention and symptom prevention. These procedures bolster accessibility, detection, and treatment, potentially curbing the necessity for hysterectomies in the case of uterine fibroids.
This article features excerpts from the BackTable OBGYN podcast. We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable OBGYN Brief
•Radiofrequency ablation uses destructive energy delivery to treat fibroids. This is done through ultrasound guidance, with newer solutions utilizing machine learning algorithms in order to increase the precision of the energy delivery.
•Radiofrequency fibroid ablation expands patient access to treatment beyond having to see a specialized surgeon, and also broadens the scope of uterine fibroids that can be treated.
•Transcervical fibroid ablation involves accessing fibroids through the cervix without incisions.
•Transcervical ablation may reshape the approach to fibroid management, providing patients with proactive treatment options that can be deployed before symptoms necessitate more invasive interventions.
Table of Contents
(1) Advancements in Uterine Fibroid Radiofrequency Ablation
(2) The Transcervical Fibroid Ablation Technique
Advancements in Uterine Fibroid Radiofrequency Ablation
Radiofrequency ablation for uterine fibroids involves a similar application to other tumor types, including those of the liver, lung, or kidney. Compared to older methods for the treatment of uterine fibroids, newer radiofrequency ablation technology offers increased efficacy and safety, according to Dr. Levy. This is because, unlike previous approaches in which the needles were inserted blindly, RFA utilizes both ultrasound guidance and machine learning algorithms to ensure that the energy is delivered precisely to the target fibroids. Precise delivery aids in safety and accessibility for patients. In addition, radiofrequency fibroid ablation allows for the detection and treatment of fibroids that may have been challenging to identify previously and therefore left untreated. On the clinician side, advancements in RFA broadens the scope of clinicians who can effectively manage fibroids, which may ultimately reduce the need for hysterectomies.
[Dr. Amy Park]
I know this is different but I just have to ask you guys as experts in the field about radiofrequency ablation. Is it just for zapping a fibroid? How does that work?
[Dr. Barbara Levy]
Radiofrequency ablation for fibroids is not dissimilar to radiofrequency ablation for liver tumors, lung tumors, or kidney tumors. It's been around a very long time. It's a destructive energy delivery system. The two that are on the market now for fibroids are ultrasound. There's a lot of machine learning that went into helping the algorithm to know exactly how long to deploy the radio frequency. It's made them far safer. In the old days, we would just randomly stick needles in and key the electrode for a while and look at it and decide, Oh, it's cooked or it's not. We don't do that anymore. These two newer technologies are very specific. They can see fibroids that we would not be able to see.
One of my problems with laparoscopic myomectomy was always the lack of my ability to feel for the princess in the pea, the fibroids that were in the myometrium that I couldn't see on the surface. Now with intra-abdominal ultrasound or intracavitary ultrasound, they're able to see all these little fibroids. I think, again, it's a democratizing technology. People who are not skilled enough to do myomectomies which are hard. You have to think through the operation. They're bloody. You have to be able to suture and suture well. This democratizes the ability to treat uterine fibroids without hysterectomy among anybody who can do laparoscopy or hysterectomy.
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The Transcervical Fibroid Ablation Technique
The transcervical fibroid ablation technique is another significant advancement in the management of uterine fibroids, offering a less invasive option. Compared to the laparoscopic approach, which is still considered minimally invasive, the transcervical method is able to treat fibroids without a single incision. This is done by inserting the ultrasound probe through the cervix, yielding visualization of fibroids, including those that are asymptomatic or small in size. In addition to it being less invasive, the procedure may be more amenable to early intervention, preventing the progression of fibroids and worsening symptoms. Dr. Hoffman posits that transcervical fibroid ablation may be able to reshape the current approach to fibroid management by offering patients a less invasive and more proactive treatment option.
[Dr. Mark Hoffman]
The two devices that are out there. One is laparoscopic. You've got a camera, you got a port for a camera. You have a port for a laparoscopic ultrasound probe that goes onto the uterus and a needle, basically, that goes through the abdominal wall and into the uterus. These little tines come out into the fibroids and you're watching it through the ultrasound probe to make sure that it's in the right spot, that it's cooking, the time, and all those things.
The transcervical approach to me is more interesting because that's still laparoscopy. It's still an abdominal entry. It's still a big procedure. Like Barbara said, myomectomy is a big surgery. I don't care how minimally invasive you do it. There's always those small fibroids, one, two-centimeter fibroids, or the asymptomatic three, four-centimeter fibroids that are there. You know they're going to grow, but do I want to do this big procedure on somebody if they're asymptomatic? Transcervically now, the ultrasound probe goes in through the cervix and the probe comes parallel to that and you can watch it through the ultrasound directly into the fibroid. Now, I'm making no incisions. The fibroids that I was going to maybe, "Do I just leave that alone or watch it?" I can get them while they're small and they never become big. That to me is a pretty radical change in thinking about how much we just go, "Oh, you have small fibroids, they're asymptomatic, ignore it, it's normal." It's not normal. It could become a problem later, or they're mildly--
[Dr. Barbara Levy]
Yes, I would argue that I would never operate on an asymptomatic patient.
[Dr. Mark Hoffman]
Asymptomatic, but not as symptomatic. Symptomatic, but they don't want a big open myomectomy or a lap myomectomy, and they're all looking for something else. Thank you for that clarification. No, 100% agree, but you're more likely to offer a procedure that is less invasive, no incision, same-day surgery. You brought up uterine artery or uterine fibroid embolization. That is ischemic necrosis of the fibroid, which ischemia is very, very painful versus RF ablation destroys fibroids via coagulative necrosis. It's not as painful. It's like our patients in our UFU program are admitted overnight, PCAs or regional anesthesia. It's very painful overnight. Even though there's no incisions, the pain is enough that they're actually admitted overnight just for pain control in our practice. Whereas for RF ablation, same-day discharge, NSAIDs, they're not really having anything close to the pain that they experience for uterine fibroid embolization.
[Dr. Barbara Levy]
Yes, what I love the most about it is, exactly to Mark's point, you can treat all the fibroids that are there. Once a patient needs a procedure for her fibroids, being able to treat all of them will avoid the reduce that happens when you can't see those ones that are pushing towards the cavity.
[Dr. Amy Park]
Got it. I don't know exactly the details. I knew it was a new hot technology and people are starting to do it. I love that about the minimally invasive gynecology crowd. We have innovation in urogynecology, of course, absolutely, but fibroids and abnormal uterine bleeding have been such a sticky problem for so long. There's truly some big advances in the field.
[Dr. Mark Hoffman]
We'll have to have a whole other episode on fibroids and new technologies because we're just getting the transcervical ablation device where I am now. We'll be starting that soon. Hopefully, I'll have done it by the time this episode airs. That's something I've been following for a very long time. It is something that I think will pretty dramatically change the approach.
[Dr. Barbara Levy]
It's evolved. Since the original design, it's far better than what the original thoughts were about it. I'm very excited about either the laparoscopic or the transcervical as opportunities for general OBGYNs, not necessarily mixed-trained, to be able to manage fibroids without telling every woman she needs a hysterectomy.
Podcast Contributors
Dr. Barbara Levy
Dr. Barbara Levy is a professor at George Washington University and a volunteer at the University of California San Diego OBGYN and reproductive sciences department.
Dr. Amy Park
Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.
Dr. Mark Hoffman
Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.
Cite This Podcast
BackTable, LLC (Producer). (2023, October 26). Ep. 37 – In-Depth: Endometrial Ablation [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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