Uterine leiomyomas affect 70% to 80% of reproductive-age women. Interventions for symptomatic patients include myomectomy, hysterectomy, uterine artery embolization (UAE), and radiofrequency ablation (RFA). Several RFA devices exist on the market. One such device is the sonography-guided transcervical ablation of uterine fibroids (Sonata), which is unique in its transcervical approach that allows for incisionless treatment.1 It can be used to treat fibroids classified as FIGO 1-6 with a radius up to 5 cm.1 Postablative therapy outcomes at 1 and 2 years have been promising for total volume reduction (mean maximal volume reduction, 63.8%) and improvement in symptoms, including quality-of-life measures and amount of bleeding (95% reported reduction).2,3
In our practice, we find this tool most helpful for medium-sized (3–5 cm) intramural fibroids and large type 2 fibroids.
In the accompanying video, we illustrate the steps for use of transcervical ultrasonographic RFA with Sonata treatment and demonstrate its impact on the uterus during simultaneous laparoscopy. We present a patient who underwent Sonata treatment for a 4-cm intramural fibroid and simultaneous laparoscopic myomectomy for a 4-cm pedunculated fibroid. This allowed for the unique ability to view the external effect on the uterus during Sonata use. We review the key surgical steps with this approach, including:
- cervical dilation
- introduction of the Sonata system
- sonographic identification of the target fibroid
- adjust size and shape of Smart Guide overlays
- deploy the introducer
- safety rotation check
- deploy the needle electrodes
- initiate RFA
- withdraw needle electrodes and introducer.
RFA with Sonata treatment is a simple, minimally invasive therapeutic option for fibroids.
We hope that you find this video useful to your clinical practice.
>>DR. ARNOLD P. ADVINCULA AND COLLEAGUES