Hysteroscopic ablation of type 2 and type 3 fibroids using radiofrequency or microwave energy

Minimally invasive, uterus-sparing radiofrequency (RF) and microwave (MW) ablation have been introduced under ultrasound or laparoscopic guidance to treat uterine fibroids. These technologies enable targeted coagulative necrosis, potentially minimising surgical time and trauma while shortening recovery. They can also be used under hysteroscopic guidance, although feasibility data is lacking.

To assess the feasibility and short-term outcomes of hysteroscopic RF and MW ablation for FIGO-type 2 and type 3 fibroids.

Four patients were included: two with FIGO-type 2 fibroids and two with FIGO-type 3 fibroids, all presenting with heavy menstrual bleeding (HMB) and no desire for pregnancy.

Procedures were performed at a tertiary care university hospital under sedation. As no evidence-based guidelines define selection criteria between MW and RF, both modalities were employed in fibroids with similar presentation. Under direct hysteroscopic visualisation, the needles were inserted through the operative channel into the myoma, maintaining a 10-mm safety margin. Tissue necrosis was confirmed by hyperechogenicity of the treated area. Each procedure lasted approximately 4 minutes. All patients were discharged the same day without complications.

Hysteroscopic ablation was technically feasible and safe in this limited case series. The procedure induced necrosis, reduced fibroid vascularisation, and resolved HMB without complications, scarring, or adhesions. Future studies are needed to evaluate long-term outcomes and determine whether it may serve as a standalone option.

Hysteroscopic myolysis may expand the therapeutic armamentarium for selected patients seeking uterine preservation. By using the natural intracavitary pathway, the technique allows precise ablation while preserving uterine integrity and minimising procedural invasiveness.