Transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids

Evidence-based recommendations on transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids in adults. This involves inserting a device through the cervix into the womb to destroy the fibroid using radiofrequency energy.

# Recommendations
Evidence on the safety of transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids raises no major safety concerns. However, evidence on its efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to do transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids should:
Inform the clinical governance leads in their healthcare organisation.
Give patients clear written information to support shared decision making, including NICE's information for the public.
Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.
During the consent process clinicians should tell patients that the procedure may not fully relieve their symptoms and further procedures may be needed.
Further research should include comparative studies, preferably randomised controlled trials. It should report details of patient selection, disease-specific quality of life and long-term outcomes.# The condition, current treatments and procedure

# The condition
Uterine fibroids (also known as uterine leiomyomas or myomas) are benign tumours of the uterine wall. They can be asymptomatic or cause symptoms including menorrhagia, intermenstrual bleeding, pelvic pressure or pain, and urinary incontinence. They can be associated with fertility problems and miscarriage.

# Current treatments
Treatment depends on whether the fibroids cause symptoms, and if the person would like to become pregnant in the future. For symptomatic fibroids, treatment options include medications, interventional radiology and surgery. Interventional radiology treatments include uterine artery embolisation and MRI-guided focused ultrasound. Surgery includes hysterectomy, myomectomy, endometrial ablation techniques and myolysis.

# The procedure
Transcervical ultrasound-guided radiofrequency ablation for symptomatic uterine fibroids is done using general or regional anaesthesia, or sedation. A radiofrequency ablation device with an ultrasound probe at the tip is inserted through the cervix into the endometrial cavity. The ultrasound probe is used to visualise and target the fibroid, which is then ablated with radiofrequency energy. The aim is to shrink the fibroid and reduce symptoms.