Transvaginal radiofrequency ablation for uterine myomas: A preliminary ecuadorian study

Background: Transvaginal radiofrequency ablation (TVRFA) is a minimally invasive, incisionless, outpatient procedure. This study evaluates the feasibility, outcomes, and complications of TVRFA in women with symptomatic uterine myomas (UMs). Methods: This preliminary single-center, retrospective study included 79 women treated with TVRFA between December 2021 and April 2024 in Quito, Ecuador. Women with 1-4 UMs of any size or type were eligible. Preoperative and follow-up assessments included transvaginal ultrasound (TVUS) for both uterine and myoma volume. Outcomes (uterine and myoma volume + complications) were assessed at 45 days and 6 months. Complications were classified by Clavien-Dindo. Statistical analyses used paired tests for baseline vs. follow-up comparisons, with missing data excluded from each analysis. Results: The median baseline uterine volume was 160.0 mL. At 6 months, this decreased to 91.0 mL (-43.1 %, p < 0.001). The median baseline myoma volume was 22.5 mL, which decreased to 7.7 mL at 45 days (-55.1 %) and 3.7 mL at 6 months (-81.5 %, p < 0.001). Follow-up was completed by 68/79 patients (86.1 %) at 45 days and 59/79 (74.7 %) at 6 months. Minor complications occurred in 12.7 %, most commonly skin burns at the electrode site. Two patients (2.5 %) experienced intestinal perforation requiring surgery. Conclusion: TVRFA significantly reduced both uterine and myoma volumes, supporting its role as a minimally invasive alternative for fibroid management. However, the observed complication rate, particularly intestinal perforation, requires critical attention to operator training and procedural refinements. Prospective studies with standardized symptom measures are warranted.