Canadian Experience with Acessa ProVu: A Case Series of the First 60 Laparoscopic Radiofrequency Fibroid Ablation...

(s): Laparoscopic radiofrequency ablation (Lap-RFA) is a minimally invasive procedure for reducing fibroid size; however, most published studies primarily focus on fibroids ≤7 cm. We describe the first Canadian case series of ultrasound-guided Lap-RFA for symptomatic fibroids, including treatment of fibroids up to 10 cm.

In this retrospective case series, an analysis was performed of consecutive ultrasound-guided Lap-RFA cases for the management of symptomatic fibroids from September 15, 2022 to May 13, 2024. The primary outcome was fibroid volume reduction at 3, 6 and 12 months postoperatively. Secondary outcomes included operative time, length of postoperative recovery stay (LOS), urgent care visits, reinterventions and subsequent pregnancies.

60 cases were identified. Median age was 43 (IQR: 37.7-46.3) with the primary indication for Lap-RFA being bulk symptoms (83.3%). The median number of fibroids was 4 with 2 (IQR 1-8) ablations per fibroid. 17 patients had concurrent myomectomies. Median operative time was 105 minutes and median LOS was 173 minutes. Median fibroid volume was 81.7 cm³ preoperatively, 49.3 cm³ at 3 months, 49.9 cm³ at 6 months and 46.1 cm³ at 12 months, a difference of 39.7%, 38.9% and 43.6% respectively (P < 0.01). Two patients had postoperative urgent care visits and one underwent reintervention. Three patients (5%) conceived a median of 141 days (IQR 74-268) postoperatively, all delivered at term.

(s): In this case series, we observed similar volume reductions as in the literature, even for fibroids 7-10 cm in size. Further studies incorporating validated patient-reported outcome measures are needed to better correlate objective outcomes with patient-reported improvement.