Combined Treatment of Uterine Leiomyoma and Ovarian Endometrioma: Transvaginal Ultrasound-Guided Radiofrequency Ablations in Five Steps

Introduction: Uterine fibroids and ovarian endometriosis are the most frequent gynecological pathologies. 1 , 2 The gold standard treatment for both is laparoscopy which almost always involves hospitalization with overnight accommodation, high costs, and surgical skills. This surgery sometimes results in long recovery times and harmful effects for patients wishing to conceive. 3 , 4 The goal of this video is to show the possibility and effectiveness of radiofrequency (RF) ablation to treat a patient affected by uterine fibroid and ovarian endometrioma with a single minimally invasive intervention. 5 , 6 Materials and Methods: A 42-year-old woman affected by menorrhagia and pelvic pain caused by a 3 cm diameter posterior uterine fibroid and a 3 cm diameter right ovarian endometriotic cyst. With a view to conservative and minimally invasive surgery, RF ablation of the uterine myoma and ovarian endometrioma was performed transvaginally (TV). The ultrasound-guided biopsy of the myoma was performed with an 18 Gauge × 25 cm disposable core biopsy instrument (Bard ® Max-Core ® ). 7 A single lumen 17G × 250 mm (Cook ® Medical) and a 35 cm long 17G internally cooled electrode with an exposed tip of 10 mm (RF STAR-Fixed—STARmed) were used, respectively, for puncture and cyst ablation. The five surgical steps described in the video are (1) myoma biopsy (histology); (2) myoma RF ablation; (3) cyst aspiration (cytology); (4) washing of the cyst; and (5) RF ablation of the cystic walls. Results: MRI follow-up at 6 months and clinical follow-up at 12 months documented reduction of the uterine fibroid volume by 70%, absence of ovarian cyst recurrence, and patient satisfaction with the procedure. Conclusions: To our knowledge, this is the first report in the literature of a combined and simultaneous treatment of a uterine fibroid and an endometriotic ovarian cyst through transvaginal ultrasound-guided RF ablations. No competing financial interests exist . I certify that during the last 3 years I have had no association with any commercial organization that might create a conflict of interest in connection with the video. Runtime of video: 10 mins 10 secs