ABSTRACT
Background
Interstitial thermal ablation represents a uterine-sparing alternative for symptomatic fibroid management. Transvaginal ultrasound-guided myolysis enables precise targeting and real-time monitoring of the ablation zone.
Objectives
To illustrate the feasibility and immediate intraoperative response of transvaginal ultrasound-guided interstitial myolysis for the treatment of uterine fibroids.
Participant
A 36-year-old multiparous woman with persistent abnormal uterine bleeding and pelvic pain related to a known uterine fibroid seeking a uterus-preserving treatment. Previous treatments, including levonorgestrel-releasing intrauterine system and oral therapy with relugolix, estradiol, and norethisterone had failed.
Intervention
Transvaginal ultrasound revealed a retroverted, enlarged uterus with a posterior type 2-5 fibroid measuring 45×37×49 mm (volume: 42.4 cm³). Under conscious sedation, a 16G-27 cm microwave antenna was transvaginally inserted and repositioned within the fibroid under continuous ultrasound guidance. Ablation was delivered in four cycles at 20 W for a total duration of 194 seconds, with a cumulative net energy delivered of 3.3 kJ calculated by the device, while continuously assessing safety margins and tissue response. Immediate ultrasound evaluation showed a 42.7% volume reduction (from 42.4 to 24.3 cm³), loss of fibroid definition, and partial collapse, consistent with effective devascularisation. No complications occurred, and the patient was discharged the same day. At 4-month follow-up, fibroid volume reduction was sustained (41.7%), with complete symptom control under the previously ineffective hormonal therapy.
Conclusions
Transvaginal interstitial myolysis offers a minimally invasive, uterine-sparing treatment option for selected patients with symptomatic fibroids. Real-time ultrasound monitoring enables precise ablation and immediate confirmation of treatment efficacy.
What is New?
This video documents the immediate volumetric response of a uterine fibroid following transvaginal ultrasound-guided myolysis.
