Stanley Rogers, M.D.
Director of Surgical Ablation
Associate Professor of Surgery
UCSF Department of Surgery
Uterine fibroids are the most common gynecologic non-cancerous tumor, affecting about three out of four women during their reproductive years. Although benign, fibroids can cause pelvic pain and heavy menstrual bleeding. Occasionally, they can affect fertility.
Clinical research here and abroad have shown that radiofrequency ablation (RFA) is effective in treating fibroids, resolving symptoms associated with more than 80 percent of patients. This new technique provides several advantages over the standard treatments available. Conventional treatments for symptomatic uterine fibroids — including hormonal drug therapy, hysterectomy, myomectomy (surgical removal of the fibroid) and uterine artery embolization — have significant limitations and undesirable side effects.
RFA is a minimally invasive procedure, so procedure pain and risk are significantly decreased. This technique avoids hysterectomy and the early onset of menopause, and may preserve a woman's fertility.
Radiofrequency energy is not new to the operating room. It has been used for decades in electrosurgical cautery units to control bleeding during open surgery.
In recent years, physicians have been exploring ways to use this heat energy to perform minimally invasive surgical procedures. Over the past 12 years, surgeons at UCSF Medical Center developed a novel laparoscopic approach to treat liver tumors using radiofrequency energy. This has become a standard treatment option
Building on our success in this area, we have recently extended laparoscopic RFA to the treatment of uterine fibroid tumors. Our team, including specialists in RFA and gynecologic surgery, has the largest reported experience in using this technique in women with symptomatic fibroids.
The procedure takes about two hours, is well-tolerated and the majority of patients return home on the same day. In some cases, it is combined with resection of the fibroid. Ninety percent of our patients reported significant improvement or complete resolution of their symptoms following surgery. We plan to compare RFA with a currently accepted minimally invasive treatment option for fibroids, called uterine artery embolization, to further establish the role of this new technology.
How It Works
Patients are first carefully evaluated to determine suitability for the procedure.
The RFA catheter is placed through the skin under ultrasound guidance into a fibroid. The catheter consists of a needle containing several prongs that are deployed into the targeted tissue, allowing ablation of a spherical volume of tissue. The prongs deliver electrical energy to the fibroid and keep the ablation catheter firmly in place during treatment.
In about 10 to 15 minutes, targeted tissue is heated to 105 C, killing tumor cells. Because the heat dissipates rapidly, surrounding normal tissue is not affected.
Most procedures are completed in two to three hours and patients discharged the same day or the day following the procedure. Complications, such as bleeding and post-operative pain, are minimal.
Laparoscopic RFA is suitable for women with symptomatic uterine fibroids. A team including surgeons and gynecologists carefully evaluates each patient.