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.

Keywords: RFA; major complication; surgical reintervention; ultrasound-guided; uterine fibroids.