INTRODUCTION: Transcervical radiofrequency ablation (T-RFA) was FDA approved in 2021 and is an incision-free, uterine-sparing, minimally invasive treatment option for patients with uterine fibroids that achieves significant reductions in menstrual blood loss, fibroid volume, and increased health-related quality of life at 12 months. However, there is no data on perioperative outcomes when T-RFA is performed with a concomitant gynecologic procedure. OBJECTIVE: Our objective was to compare intraoperative and postoperative outcomes among patients undergoing T-RFA to those undergoing T-RFA with a concomitant procedure. METHODS: We conducted a retrospective cohort study of patients who underwent T-RFA between May 2024 and September 2025. Sociodemographic information, relevant health history, perioperative details, and postoperative outcomes were collected from electronic medical records. Exploratory analysis was performed to evaluate the following variables for T-RFA with or without a concomitant procedure: postoperative complications, postoperative infection, vaginal discharge, ED visit, readmission, postoperative complaint, IUD complaint, re-operation rate, OR time, EBL, PACU time, postoperative pain scores, and morphine milliequivalents (MME) required in PACU. RESULTS: Twenty-nine patients underwent T-RFA. The mean age was 44.7±6.8 years and the mean BMI was 32.8± 5.8 kg/m 2. Self-identified race was 48.3% Black, 34.5% White, and 17.2% Other. Fifteen patients (51.7%) had 5 cm. One or more concomitant procedures were performed with T-RFA for 22 (75.9%) of patients, including dilation and curettage (69.0%), hysteroscopy (31.0%), hysteroscopic endomyometrial resection (24.1%), and levonorgestrel IUD insertion (20.7%). The groups were similar in baseline characteristics (Table 1). There were no statistically significant differences in postoperative infections, vaginal discharge, ED visits, readmission, postoperative complaints, or re-operation rate (Table 2). Additionally, there were no significant differences in OR time, EBL, PACU time, or MME in PACU between groups. While our small sample size introduces the possibility of type II error, the percentages reported in Table 2 suggest that the outcomes are unlikely to have clinically important differences despite our small cohort. A total of 6 patients underwent IUD insertion at the time of T-RFA. Of these, 3 (50%) had a malpositioned IUD and subsequently underwent IUD removal. While the sample size is small and we did not have an internal comparison group that underwent IUD insertion without concomitant RFA, our 50% malposition rate is significantly different from the ACOG published rate of 16.6% (p=0.028). CONCLUSIONS: In this cohort study, concomitant procedures performed at the time of T-RFA did not significantly impact most intraoperative or postoperative outcomes. These findings suggest that T-RFA may be performed in combination with other minor gynecologic procedures. However, a markedly elevated IUD malposition and subsequent removal rate of 50% was observed and raises concern about performing these with T-RFA. Despite our small sample size, patients should be counseled preoperatively, and delayed placement should be considered. Larger studies are needed to confirm these findings, evaluate safety, and guide patient counseling.Table 1Table 2
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