Impact of Transcervical Radiofrequency Ablation of Uterine Fibroids on Operating Room Time and Postoperative Pain

INTRODUCTION: The Sonata® transcervical radiofrequency ablation (T-RFA) system was FDA approved in 2021 as a minimally invasive management option for uterine fibroids. Studies report reductions in fibroid volume, menstrual blood loss, and increased health-related quality of life at 12 months. There is limited data on how preoperative fibroid size and number impact perioperative outcomes. OBJECTIVE: To assess the impact of fibroid size and number on postoperative pain scores, estimated blood loss (EBL), operating room (OR) time, PACU time, and morphine milliequivalents (MME) required in PACU following T-RFA. METHODS: We conducted a retrospective cohort study of 29 patients who underwent T-RFA between May 2024 and September 2025. Electronic health records were reviewed for sociodemographic variables, relevant history, fibroid characteristics, and perioperative outcomes. Descriptive analyses and subgroup analyses were conducted by fibroid number (n0.05). When comparing outcomes by size of largest fibroid (0.05). Time in PACU was shorter with larger fibroids (84.5 76.5, 99.3 min vs 100.0 92.0, 139.0 min, p=0.023). This study may be subject to type II error given the small sample size, although the observed differences (Table 2) do not appear to reach clinical importance even if we had been appropriately powered. CONCLUSIONS: This retrospective cohort study suggests fibroid number and size have limited impact on clinical outcomes for patients undergoing T-RFA. A slightly higher EBL (Δ=10 mL) was observed in the n≥5 fibroid group, and PACU time was shorter with fibroids ≥5 cm (Δ=15.5 minutes). However, both were unlikely of clinical significance. This preliminary data highlights that T-RFA may have similar outcomes for patients with varying fibroid burden. Larger studies are needed to confirm these findings, to inform procedural planning and patient counseling.Table 1Table 2