Design: Single arm retrospective study (N=17) patients with myomas who underwent transcervical RFA followed by hysteroscopic resection. Data were analyzed with an emphasis on descriptive statistics.

Setting: One academic NYC teaching hospital

Patients or Participants: Reviewed procedures booked with CPT codes used for Sonata (0404T or 5850) and Truclear System (58561) between October 2022 and April 2024 for 4 MIGS. Only patients who underwent Sonata first followed by truclear were included. Patient characteristics, procedure details, and outcomes were retrieved from electronic records.

Interventions: Patients included underwent RFA with Sonata followed by hysteroscopic myoma resection in single session.

Measurements and Main Results: 17 patients (median age: 42) underwent the combined procedure. Treated and resected fibroids included 9 FIGO Type 1 (median size: 4cm, range: 2-5cm), 8 FIGO Type 2 (median size: 4.5cm, range: 2-5cm), 2 FIGO Type 3 (median size: 5.75cm, range: 3.5-8cm), and 1 FIGO Type 5 (size: 4cm). Median blood loss and fluid absorption for Type 1 fibroids were 5cc and 1820cc, respectively, with 7 out of 9 fibroids completely resected. For Type 2, these values were 20cc and 1200cc with 4 out of 8 fibroids fully resected. Type 3 fibroids showed a median blood loss of 27.5cc and fluid absorption of 782.5cc, with 2 of 3 fully resected. The single Type 5 fibroid had 5cc blood loss and 265cc fluid absorption, and was fully resected. No complications or vasopressin usage was reported. Follow-up data indicated symptomatic improvement in 15 of 17 patients without further intervention, while 2 required surgical re-intervention.

Conclusion: Transcervical RFA combined with hysteroscopic resection is a safe and feasible, demonstrating low intraoperative and postoperative complications. Comparative studies with other fibroid pre-treatment methods, such as uterine fibroid embolization or medical treatment with GRNH agonists/antagonists, are warranted.