Radiofrequency and microwaves for gynaecological pathology - Prof. Antonio La Marca
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Prof. La Marca receives by appointment at the Policlinico di Modena.

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Prof. Antonio La Marca

Radiofrequency and microwaves for gynaecological pathology

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Radiofrequency and microwaves for gynaecological pathology

Radiofrequency and microwaves have been introduced into our clinical practice with excellent results. Prof La Marca is considered among the pioneers for the use of this procedure in gynaecology and receives patients from all over the country for the ultra minimally invasive treatment of uterine fibroids and adenomyosis.

The use of radio frequencies and microwaves represents a new frontier for the treatment of uterine fibromatosis and is a minimally invasive procedure that allows effective treatment with minimal impact on both the clinical condition of patients and health economics.

Recent data have demonstrated the safety and efficacy of this procedure, with resolution or improvement of symptoms and significant reduction in the volume of fibroids treated. At the same time, they have demonstrated the efficacy and high tolerability of this procedure, leading to both a reduced need for re-intervention and easy post-operative management, manageable even with only the use of NSAIDs for post-operative pain. [Lee BB et al. 2016]
 
Uterine fibromatosis is a major problem in women's health, affecting up to 70% of Caucasian women and up to 80% of African-American women by the age of 50, and is a major indication for hysterectomy. [Day Baird D et al. 2003].
 
Radiofrequency treatment takes advantage of recent technological advances in instrumentation and imaging to provide a safe, effective and conservative approach to the uterus. [Lee BB et al. 2016]
 
This method is based on the production of a high-frequency, low-voltage alternating current by means of an electrode that, when positioned at a target tissue, produces heat that spreads by thermal conduction, allowing its volumetric ablation by coagulative necrosis. Heat can be applied by direct thermal conduction, as in endometrial ablation by heated fluid, or by ultrasound or microwaves. [Lee BB et al.2016]
 
The size and shape of the ablation volume are dependent on the time taken, the maximum temperature reached and the type of electrode used. [Lee BB et al.2016]
 
The additional advantage of this method is that, by using frequencies typically between 450 and 500 kHz, it prevents nerve stimulation at the level of the tissue involved, which typically occurs at frequencies below 10 kHz. [Hammerich D. et al. 2006].
 
Microwave ablation, on the other hand, uses the creation of an electromagnetic field around an electrode that leads to an increase in local temperature and coagulative necrosis in the target tissue.
 
The first use of radiofrequency in the treatment of uterine fibromatosis dates back to 2002, when Lee et al. demonstrated how, in a sample of 52 patients with a total of 197 leiomyomas ranging in size from 1 to 11 cm, this method led to a reduction in fibroid volume of 36% at three months and 41% at six months after treatment, with a resolution of symptoms up to 90% one year after treatment. There were also no complications at surgery or peri-operatively. [Lee BB. et al. 2002].
 
During the 3-year follow-up, Lee et al. also demonstrated that 94% of the treated sample was still asymptomatic, with only one re-intervention for symptomatic fibromatosis 23 months later. [Lee BB et al. 2005]
 
In 2005, Lee initiated the design of a new radiofrequency ablation method, called the Acessa System, which received FDA approval for the treatment of uterine fibromatosis in 2012. [Lee BB et al. 2016]
 
Although evidence on the efficacy of myolysis has generally been reported using a laparoscopic approach, in 2011 Chung-Hoon Kim et al. verified the efficacy and reliability of radiofrequency myolysis using an echo-guided transvaginal approach. [Kim CH et al. 2011] In a sample of 69 women with an average age of 39.8 years with symptomatic uterine fibromatosis, data on the volumetric reduction of fibroids by ultrasound study, the degree of resolution of menorrhagia, and the overall improvement in symptoms associated with fibromatosis were analysed. All the results obtained, which confirmed a reduction in the volume of dominant myomas and an improvement in menorrhagia and associated symptoms one, three, six and twelve months after treatment, were statistically significant. [Kim CH et al. 2011].
 
A final very interesting fact concerns the 15 pregnancies that occurred in 13 patients with live births after radiofrequency treatment for fibroids. Of these, 14 pregnancies occurred after laparoscopic echo-guided treatment, with 12 deliveries occurring at term with live, viable fetuses and 2 miscarriages in the first trimester; only one pregnancy occurred after transuterine treatment. Of these 13 total deliveries, 8 occurred by caesarean section and 5 through vaginal deliveries. [Lee B et al., 2016]
 
International literature also reports initial positive experiences in the treatment of adenomyosis. This uterine pathology correlates with symptoms of increasing intensity including dysmenorrhoea, metrorrhagia and infertility. Hence the need for therapeutic strategies that must obviously be customised on the basis of the symptom of the extent of the pathology. Thermo-ablation represents a new therapeutic tool that, with a non-invasive approach, therefore permits the effective treatment of this insidious pathology.
 
In conclusion, it can be seen that the use of radiofrequencies and microwaves by transvaginal ultrasound represents a very promising frontier in the treatment of gynaecological pathologies such as uterine fibromatosis and adenomyosis, with a good post-operative prognosis in terms of symptoms and post-operative recovery, and with significant health savings, allowing shorter operating times and a net reduction in the hospitalisation of patients.
 

Lee BB, Yu SP. Radiofrequency Ablation of Uterine Fibroids: a Review. Curr Obstet Gynecol Rep. 2016;5(4):318-324. doi: 10.1007/s13669-016-0183-x.

Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100-107. doi: 10.1067/mob.2003.99.

Hammerich D. Tissue ablation. In: Webster JG, editor. Wiley encyclopedia of medical devices and instrumentation. New Jersey: John Wiley & Sons; 2006. pp. 362-379.

Huang K, Hong R, Luo L, Zhao H, Wang Y, Li Y, Jiang Y, Zhou H, Li F. Efficacy and safety of different thermal ablative therapies for desmoid-type fibromatosis: a systematic review and meta-analysis. Quant Imaging Med Surg. 2023 Oct 1;13(10):6683-6697. doi: 10.21037/qims-23-289.

Lee BB. Radiofrequency ablation of uterine leiomyomata: a new minimally invasive hysterectomy alternative. Obstet Gynecol. 2002;99(4s):9S.

Lee BB. Three-year follow-up post radiofrequency ablation of uterine leiomyomata. J Min Inv Gynecol. 2005;12(5s):S51. doi: 10.1016/j.jmig.2005.07.121.

Kim CH, Kim SR, Lee HA, Kim SH, Chae HD, Kang BM. Transvaginal ultrasound-guided radiofrequency myolysis for uterine myomas. Hum Reprod. 2011;26(3):5599-5563. doi: 10.1093/humrep/deq366.

Ierardi AM, Savasi V, Angileri SA, Petrillo M, Sbaraini S, Pinto A, Hanozet F, Marconi AM, Carrafiello G. Percutaneous High Frequency Microwave Ablation of Uterine Fibroids: Systematic Review. Biomed Res Int. 2018 Jan 8;2018:2360107. doi: 10.1155/2018/2360107.

Berman JM, Guido RS, Garza-Leal JG, Pemueller RR, Whaley FS, Chudnoff SG. Three-year outcome of the halt trial; a prospective analysis of radiofrequency volumetric thermal ablation of myomas. J Min Inv Gynecol. 2014;21(5):767-774. doi: 10.1016/j.jmig.2014.02.015.

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Performances

Myolysis or thermoablation of uterine fibroids

Myolysis or Thermoablation is a technique currently only performed in a few centres. Prof La Marca personally handles the method and receives patients from all over the country to perform this innovative therapy.

Radiofrequency and microwaves for gynaecological pathology

Radiofrequency and microwaves have been introduced into our clinical practice with excellent results. Prof La Marca is considered among the pioneers for the use of this procedure in gynaecology and receives patients from all over the country for the ultra minimally invasive treatment of uterine fibroids and adenomyosis.

In vitro fertilisation

In vitro fertilisation is a therapeutic strategy that is far from standardised. Like all medical and surgical practices, it is greatly affected by the technical skills and cultural updating of the practitioners involved. The results are therefore by far operator-dependent. This aspect is very little known, both by clinicians and patients.

Gynaecological endocrinology

The ovarian and menstrual function of women is extremely delicate and responds to a complex interaction between the centres (hypothalamus-pituitary) and the periphery (ovary-uterus).

Transfer to the blastocyst stage

In in vitro fertilisation, fertilised oocytes (zygotes) are kept in the laboratory, in incubators, under controlled temperature conditions (37°C) and an atmosphere with 5% oxygen and 6% carbon dioxide.

Infertility

It is well known that a considerable percentage of couples experience difficulties in conceiving. It is estimated that 10-15% of the population can be classified as infertile.

Recurrent abortion

Miscarriage is defined as a termination of pregnancy that occurs spontaneously within 24 weeks of gestation.

Diagnostic and operative hysteroscopy

Diagnostic Hysteroscopy is an endoscopic technique that can be performed in an outpatient setting using a hysteroscope.

Heterologous fertilisation

For certain clinical conditions, couples desiring offspring must resort to gametes (oocytes and/or spermatozoa) from voluntary and disinterested donors in order to fulfil their reproductive desire.

Fertility preservation

Over the past three decades, a phenomenon has taken hold in the Western world that is likely to have major implications for birth rates: the scheduling of births at a significantly older age than in the past.

Gynaecology and obstetrics

Gynaecology and Obstetrics is the medical discipline par excellence in the care of women. The aim of this clinical speciality has always been to care for the patient in all phases of her life.

Diagnosis and treatment of adenomyosis

At our clinic, the diagnosis and therapy of adenomyosis is performed to the most up-to-date standards. Prof La Marca is among the clinicians with the most experience in treating adenomyosis with thermoablation, an innovative therapeutic strategy for this disease.

Diagnostic examinations

Diagnostic examinations in gynaecology and obstetrics are nowadays very accurate and their correct execution and interpretation are the basis for the right clinical picture of the patient and the most appropriate therapeutic strategy.

Fibroids therapy

Uterine leiomyomas, more commonly called fibroids, are benign solid neoformations and represent the most frequent gynaecological neoplasm in women of childbearing age.

Uterine anomalies

An arrest of the organogenic stages can cause uterine and vaginal abnormalities of varying degrees.

Endometriosis

Endometriosis is a chronic, oestrogen-dependent inflammatory disease characterised by the presence of functional endometrial tissue (glands and stroma) in extrauterine sites.

Menstrual cycle disorders

It represents the most obvious and measurable clinical sign of pubertal maturation and in most women it occurs about two to three years after the onset of telarche with an average age of around 12½ years.

Intrauterine insemination

A Level I medically assisted procreation procedure based on the deposition of spermatozoa directly inside the uterine cavity. This procedure is carried out after ovulation induction.

Outpatient ultrasound aspiration of ovarian cysts

At our clinic, Prof La Marca personally handles the method. Ultrasound-guided aspiration of ovarian cysts is an ultra-mini-invasive method that is only available in very few centres nationwide. If there are the right indications, the method allows a rapid and non-invasive solution for the pathology in question

Tubal recanalisation

At our clinic, Prof La Marca personally handles the method. Endoscopic tubal recanalisation, where indicated, is today performed in only a few centres throughout Europe. The expertise is therefore concentrated in a limited number of experts capable of performing it correctly.

Assisted laser hatching

Laser-assisted hatching (LAH) is a laboratory technique that consists of cutting a small section of the zona pellucida (ZP).

IMSI, intracytoplasmic sperm injection

This is a level II technique used in the field of in vitro fertilisation. It takes the form of a variant of traditional ICSI, both of which consist of the direct injection of a spermatozoon into the cytoplasm of the oocyte.