Combined transcervical radiofrequency ablation and hysteroscopic myomectomy: expanding treatment to diverse fibroid types

Introduction

Uterine fibroids are highly prevalent and often symptomatic, leading to abnormal uterine bleeding (AUB) and impaired quality of life. While hysteroscopic myomectomy (HSC) is the gold-standard treatment for submucosal fibroids, it is limited in addressing deeper lesions. Transcervical radiofrequency ablation (TFA) offers a minimally invasive alternative for intramural and transmural fibroids. This study evaluated the safety and effectiveness of combining TFA with HSC in a single session compared to HSC alone.

Study design

We conducted a retrospective multicenter analysis of 127 women with symptomatic fibroids and AUB. Patients underwent either combined TFA + HSC (n = 75) or HSC alone (n = 52). Outcomes included intraoperative bleeding, complications, and symptom improvement.

Results

The combined group treated a broader range of fibroid types (FIGO 0–6) and larger fibroids (mean size 2.86 cm vs. 2.23 cm; p = 0.0013). Intraoperative bleeding was significantly lower in the combined group (0% vs. 9.6%; p = 0.0102), with no increase in total complication rates (8% vs. 15%; p = 0.2512). Among patients with follow-up data, 85.1% reported symptom improvement after combined treatment.

Conclusion

Combining TFA with hysteroscopic myomectomy is a safe and effective approach that expands the range of treatable fibroids, reduces intraoperative bleeding, and maintains high patient satisfaction. This integrated strategy offers advantages in tissue diagnosis, potential cost savings, and uterine preservation, making it a valuable addition to minimally invasive fibroid management.