Comparison of Clinical Outcomes Among Patients Undergoing Transcervical Radiofrequency Ablation Versus Minimally Invasive Myomectomy

INTRODUCTION: Uterine leiomyomas affect up to 70% of women by menopause and are associated with abnormal uterine bleeding and bulk-related symptoms. Management of fibroids has expanded to include minimally invasive techniques such as radiofrequency ablation (RFA). Laparoscopic RFA has been shown to reduce hospitalization, blood transfusion rates, and operative time compared with myomectomy. However, outcomes following transcervical RFA remain understudied. OBJECTIVE: The aim of this study is to explore differences in demographic and surgical variables, including area of deprivation index (ADI) and distance traveled for treatment, among patients with fibroids undergoing transcervical radiofrequency ablation (T-RFA) versus minimally invasive myomectomy. METHODS: This is a retrospective cohort study of patients who underwent T-RFA and minimally invasive myomectomy from January 2021 through December 2024 at three tertiary academic medical centers located in Florida, Minnesota, and Arizona. All T-RFA procedures were included, and age-matching was performed to obtain a 1:1 cohort of patients who had laparoscopic or robotic myomectomy. Abdominal myomectomy was excluded due to the increased invasiveness of the procedure. RESULTS: The cohort included 103 patients who underwent transcervical radiofrequency ablation of fibroids (T-RFA) and 105 age-matched patients who underwent minimally invasive myomectomy at three major academic institutions. There were no differences in mean age (45.5 years in the T-RFA group vs 44.5 years in the myomectomy group) or mean body mass index (28.8 for T-RFA vs 28.5 for myomectomy). There were more nulliparous patients in the myomectomy group (p=0.0003). There were no differences in the ADI national percentiles or miles traveled to access treatment between T-RFA and myomectomy groups. Preoperative hemoglobin was significantly lower in the T-RFA group (12.1 vs 12.7, p=0.008), and procedural loss was higher in the myomectomy group (271.2 mL vs 22.1 mL, p=0.0001). CONCLUSIONS: Patients who underwent T-RFA had significantly lower procedure-related blood loss compared to minimally invasive myomectomy despite similar demographic factors and lower preoperative hemoglobin levels. Additional data regarding outcomes, including need for further treatment, differences in fibroid characteristics, bleeding profile, and fertility, are being evaluated.