Canadian Experience with Acessa ProVu: A Case Series of the First 60 Laparoscopic Radiofrequency Fibroid Ablation Procedures at a Single Centre.

OBJECTIVE: (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. METHODS: 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. RESULTS: 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. CONCLUSION: (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.