Laparoscopic Fibroid Ablation Linked to Higher Treatment Failure Than Myomectomy

An analysis of the multicenter prospective ULTRA study compared laparoscopic radiofrequency ablation (RFA; n=231) with laparoscopic myomectomy (n=110) for symptomatic uterine leiomyomata. The primary endpoint was a subsequent procedure for leiomyomata within two years, defined as surgical failure. A secondary composite included surgical failure or self-reported failure, such as persistent symptoms affecting quality of life.

Surgical failure occurred in 15.2% of the RFA group versus 3.8% of the myomectomy group (adjusted odds ratio [aOR] 4.17; 95% CI 1.39–12.50). Composite failure occurred in 46.4% versus 25.5%, respectively (aOR 3.18; 95% CI 1.80–5.60). Submucosal leiomyomata were associated with RFA failure (OR 2.76; 95% CI 1.21–6.28), as were lateral leiomyomata (OR 2.49; 95% CI 1.32–4.69).

These findings may inform counseling about repeat procedures and persistent symptoms following either treatment. However, the groups differed significantly at baseline: patients undergoing RFA were older and had higher BMI, gravidity, and parity. Although models adjusted for selected covariates, residual confounding remains possible, and the findings establish associations rather than causation. The composite endpoint also incorporated patient-reported failure rather than repeat procedures alone.