Safety of percutaneous microwave ablation under local anesthesia for uterine fibroids and adenomyosis.

objectiveThis study explored the incidence of adverse events (AEs) following microwave ablation (MWA) under local anesthesia and analyzed factors related to benign uterine diseases, including uterine fibroids (UFs) and adenomyosis (AM). MATERIALS AND

methodsOverall, 366 patients who underwent percutaneous MWA were finally included in this study. Univariate and multivariate logistic regression analyses were performed to identify the main factors affecting AEs.

resultsThe overall AEs rate for benign uterine disease was 77.32% (283/366), and was significantly higher in patients with AM than in those with UFs (95.38% vs. 73.42%, p < 0.001). AM (odds ratio (OR) = 3.77, p = 0.039) and higher transformed symptom severity score (higher tSSS) (25-40: OR = 2.98, p = 0.007; > 40: OR = 2.36, p = 0.022) were independent risk factors for AEs. In the subgroup analysis of patients with UFs, moderate-to-severe pain during MWA was significantly associated with AE occurrence (OR = 2.35, p = 0.048) and abdominal pain (OR = 3.63, p < 0.001). Although multivariate regression analysis showed that higher tSSS (25-40: OR = 3.22, p = 0.003; > 40: OR = 3.32, p = 0.001) was an independent influencing factor for vaginal discharge, univariate analysis suggested that vaginal discharge risk also increased with FIGO 0-3 (OR = 2.53, p = 0.010).

conclusionOur results demonstrated that AM and higher tSSS were identified as significant independent risk factors, facilitating better patient selection and improved patient counseling. Moderate-to-severe pain during MWA was strongly associated with AE occurrence, highlighting the need for further investigation of anesthesia optimization. Further, patients with FIGO 0-3 fibroids exhibited a higher risk of postoperative vaginal discharge, necessitating procedural refinement to preserve endometrial integrity. CRITICAL RELEVANCE STATEMENT: Our study makes a significant contribution to the literature because it provides a comprehensive analysis of microwave ablation-related adverse events and their associated risk factors, facilitating better patient selection, procedural refinements, and improved patient counseling. KEY POINTS: This study addresses a critical gap in the literature by investigating the safety of ultrasound-guided microwave ablation (MWA) for uterine fibroids (UFs) and adenomyosis (AM) under local anesthesia. Our results demonstrated the overall AE rate for UFs and AM following MWA was 77.32%, with AM and higher transformed symptom severity scores identified as significant independent risk factors. Given the differences in AE risk between UFs and AM, as well as related risk factors, tailored treatment protocols should be considered to optimize outcomes.