Simultaneous Use of Ultrasonically Guided Transcervical Microwave Myolysis for Myomas and Adenomyosis and Microwave Endometrial Ablation for Menorrhagia

Objective: Microwave endometrial ablation is widely used instead of hysterectomy for menorrhagia. However, it can not be used for large myomas or deep adenomyosis. To treat myomas and adenomyosis, we developed a transcervical microwave ablation system, and performed ultrasonically guided transcervical microwave myolysis. Materials and Methods: Microwave (2.45 GHz) was introduced through coaxial cables to 2 types of microwave applicators: 1) a curved (diameter: 4 mm) for endometrial ablation, and 2) a needle-type (diameter: 1.6 mm) for myolysis. Once microwave endometrial ablation was completed, the needle-type applicator was placed in the myoma by transcervical introduction into the uterine cavity and puncturing, using a puncture adaptor attached to a transvaginal ultrasonic probe. Microwave irradiation was administered at 17 W for 10 min. Five patients waiting for microwave endometrial ablation of organic menorrhagia, caused by myomas or adenomyosis entered the study after giving complete informed consent. The study was approved by the Ethics Committee of Osaka City University Hospital. Results: In 4 patients with myomas, the major part consisting of a submucous or an intramural node of 6 to 7 cm in size, was irradiated by microwave and necrotized. The myoma nodes shrank by 17 to 53% in the following 3 months. The patient with adenomyosis showing a uterus greater than a newborn’s head in size became amenorrheic, and the uterus size decreased by 31% three months after the operation. No remarkable complications were encountered. Discussion: Transcervical microwave myolysis is feasible, and can quickly treat usual myomas or adenomyosis.