Transvaginal radiofrequency ablation of a myoma in 10 key steps

Objective: To describe transvaginal radiofrequency ablation of myomas (TRAM) in 10 key steps.

Design: Video article.

Setting: University hospital.

Patient(s): A 38-year-old woman presented with menometrorrhagia and consequent chronic anemia (hemoglobin 8.5 g/dL) caused by a cervical myoma measuring 51 cm³. Initially, a cervicovaginal embolization was performed, but without any improvement in symptoms. Given the complex position of the myoma (close proximity to the uterine arteries), as well as the patient's desire for future pregnancies, a TRAM was proposed.

Intervention(s): Not applicable.

Main outcome measure(s): Volume of myoma and menometrorrhagia 6 months after treatment.

Result(s): Not applicable.

Conclusion(s): Transvaginal radiofrequency ablation of myomas is a quick, simple, minimally invasive, and easily reproducible technique. It could be an interesting alternative to the conventional laparoscopic and open-surgical treatments of myomas. There is a lack of high-quality data establishing TRAM safety in infertility and pregnancy. The only available radiofrequency ablation device in the United States has specific language stating that this procedure is not recommended for women considering future pregnancy.