title: Percutaneous image-guided radiofrequency thermal ablation for large symptomatic uterine leiomyomata after uterine artery embolization: a feasibility and safety study.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of percutaneous image-guided radiofrequency ablation (RFA) performed with moderate sedation for large symptomatic uterine leiomyomata.
  
  
  METHODS
  Women with large (>5 cm in diameter) symptomatic subserosal and/or intramural uterine leiomyoma were recruited for a prospective study. Patients underwent percutaneous RFA following UAE. RFA using 5 cm treatment diameter expandable needle electrodes connected to a 460 kHz monopolar RF generator, which was performed with a target temperature and power set at 85 degrees C and 150 watts respectively, with a target temperature ablation time of 10 minutes. Patients were assessed for complications in perioperative and post-procedure periods at 24 hours and 1 month, and for symptom improvements at 6 months.
  
  
  RESULTS
  Thirty-five patients (mean 43.8 years +/- 6.2) were recruited. RFA targeting ablation size and temperature was achieved in 97% of the patients (34/35). There were no immediate percutaneous RFA-related complications. There was a self-limiting delayed drainage via the transabdominal RFA access track in one patient (2.9%), a urinary tract infection in one patient (2.9%) and post-embolization/post-ablation symptoms in three patients (8.6%). The mean transformed symptom severity score (SSS) as a part of the uterine fibroid symptom and quality of life (UFS-QOL) assessment shows that the improvements at 1 month were 24.3 points ( P < 0.001) and at 6 months were 40.4 points ( P < 0.001). Mean volume reduction of leiomyomata was 286.8 cm(3) or 56.5% ( P = 0.0015).
  
  
  CONCLUSIONS
  Percutaneous image-guided RFA as adjunctive to UAE under moderate sedation is feasible, and appears safe without significant morbidity in the treatment of large uterine leiomyomata.
authors.affiliation: The Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. sikhkim@jhmi.edu
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.forename: Jason
authors.initials: J
authors.lastname: Tsai
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jacobs
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
mesh_terms: D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018231:Leiomyomatosis / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery* / Q000628:therapy; D014599:Uterus / Q000098:blood supply