Ultrasound-guided transabdominal microwave ablation versus laparoscopic myomectomy for FIGO type 3-5 uterine fibroids: a retrospective comparison of efficacy and safety.

OBJECTIVE: This retrospective cohort study aimed to compare the efficacy and safety of ultrasound-guided transabdominal microwave ablation (MWA) and laparoscopic myomectomy (LM) for intramural uterine fibroids (FIGO type 3-5). METHOD: Our retrospective study included 60 patients with uterine fibroids undergoing MWA (n = 23) or LM (n = 37). Patients in these groups were compared for baseline characteristics, symptom improvement, operation time, postoperative hospital stay, medical costs, and postoperative complications. For the MWA group, changes in fibroid volume were also investigated. Intergroup comparisons in continuous variables were performed using the Mann-Whitney U test, and intragroup comparisons were assessed by the Wilcoxon signed-rank test. Categorical variables were compared using the Chi-square or Fisher's exact test. RESULT: At 6-month of follow-up, no statistically significant difference in overall symptom resolution was observed between the MWA and LM groups (P = 0.18). Regarding fibroid volume, the most pronounced reduction occurred within the first 6 months, with the median volume decreasing from 96.46 ml at baseline to 44.23 ml at 6 months (P < 0.001), representing a median VRR of 58.27%. Thereafter, the reduction rate gradually slowed. When analyzed by FIGO subtype, type 3 fibroids showed the most pronounced reduction at 3 months, whereas type 4 fibroids exhibited the greatest reduction at both the 6- and 12-month evaluations. Although operative time was comparable between groups (P = 0.17), MWA was associated with significantly shorter postoperative hospital stay (P < 0.001) and lower overall costs (P = 0.01). Moreover, no major complications (e.g., adjacent organ injury, massive hemorrhage, or severe infection) occurred in either group. Minor complications occurred in both groups with comparable incidence (P = 0.72) and all resolved with symptomatic management. CONCLUSION: Both MWA and LM demonstrated comparable short-term efficacy and safety for FIGO type 3-5 fibroids in our cohort. In addition, MWA offered significantly shorter hospital stay and lower treatment costs, suggesting that it may represent a minimally invasive and potentially cost-saving treatment option.