Safety and effectiveness of transcervical radiofrequency ablation for uterine fibroids in patients with obesity: a retrospective cohort study

Abstract Key message Transcervical radiofrequency ablation is a low-risk, uterus-preserving option for symptomatic fibroids in women with obesity with significant improvement of bleeding disorder, including ≥ 40 kg/m 2 . Obesity should not preclude offering TFA. Objective To evaluate the safety and effectiveness of transcervical radiofrequency ablation (TFA) for uterine fibroids in women with obesity. Methods Retrospective multicenter cohort at two German Fibroid Centers. From 574 consecutive TFA cases, we included patients with BMI ≥ 30 kg/m 2 and ≥ 6-month follow-up; those with incomplete data were excluded. Fibroids were characterized by ultrasound. TFA (Sonata®) was performed per instructions for use. Outcomes were perioperative complications and patient-reported improvement in abnormal uterine bleeding (AUB). Results Sixty patients were analyzed (age 43.59 ± 6.52 years; BMI 35.72 ± 6.72 kg/m 2 ). Mean operative and ablation times were 33.65 and 9.91 min, respectively. One intraoperative bleeding event (1.7%) was controlled with a balloon catheter; no postoperative complications occurred. Mean follow-up was 17.08 months (6–54). Overall, 42/60 (70.0%) reported AUB improvement. By BMI category: 30–34.9 kg/m 2 25/39 (64.1%), 35–39.9 kg/m 2 5/7 (71.4%), ≥ 40 kg/m 2 12/14 (85.7%) (p = 0.3168). Considering the initial assessment, 48/60 (80.0%) improved; six later recurred, yielding 42/60 (70.0%) at last follow-up. Conclusion TFA showed a very low complication rate and clinically meaningful bleeding improvement in women with obesity, with comparable outcomes across BMI strata, including ≥ 40 kg/m 2 . Obesity is not a barrier to safe, effective TFA. Prospective, BMI-stratified studies with validated bleeding measures and objective endpoints are warranted.