the study was conducted in the department of obstetrics and gynecology at chosun university hospital . from july 2008 to july 2013 , 272 reproductive female patients ranging from 32 to 47 years old who suffered midline dysmenorrhea were enrolled in a non - randomized prospective study . one hundred and thirty - two patients were in the lrfm group , 140 patients were in the urfm group . two hundred and seventy - two patients who had undergone surgery were prospectively surveyed regarding dysmenorrhea before and 1 year after rfm . all patients were informed the risks and benefits of laparoscopic rfm . before rfm as well as 1 year after surgery , they all completed a questionnaire that requested information on the severity of dysmenorrhea on a 0 to 4 pain score , which was similar to that devised by chen.8,9 severity of dysmenorrhea in all patients was scored in a 5-point scale ranging from 0 to 4 ( i.e. , 0 = no pain , 1 = mild pain requiring no medication , 2 = moderate pain responding to mild pain relievers , 3 = severe pain necessitating potent pain relievers , and 4 = incapacitating pain unresponsive to potent pain relievers ) . and we treated women whom they do n't want to have a baby anymore ; because of not being proven the relationship between rfm , with pregnancy and side effects . lrfm of uterine myomas was performed under local anes thesia using diazepam ( 20 mg ) and pethidine ( 100 mg ) intravenously . a uterine manipulator was inserted for better exposure of the myomas puncture site to be treated . then , a 2 mm trocar was inserted through an umbilical incision after injection of lidocaine . the rf needle was inserted percutaneously after insufflating co2 gas into the pelvic cavity , and placed within the target myoma under laparoscopic video guidance . the depth of the needle insertion was determined on the basis of a pre - operative ultrasound . the tip of the central prong was placed about 1 - 4 cm beyond the center of the myoma by size , so that the peripheral electrodes were localized where the cross - sectional area of the myoma was largest . the target temperature for rfm was 80. a rf generator ( rf medical , seoul , korea ) automatically adjusts the power to maintain the selected temperature . lrfm group , a video 2 mm laparoscope was inserted via a troca placed through a subumbilical incision . , we filled the pelvic cavity with adept ( baxter , vienna , austria ) and sprayed using a 16 g spinal needle on the region for preventing adhesions after rfm . the laparoscopy equipment was made by karl stortz gmbh & co ( tuttlingen , germany ) . urfm of uterine myomas was performed under local anesthesia using diazepam ( 20 mg ) and pethidine ( 100 mg ) intravenously . in the lithotomy position , urfm group underwent transvaginal insertion of an ultrasonic needle into the center of the myoma(s ) or lesion before myolysis . the diagnostic ultrasound system was made by toshiba nemio ( ssa-550a ; toshiba medical systems corp . , the mann - whitney u test and chi - square test were employed to compare age , operation time , length of hospitalizaton and post - operative dysmenorrhea pain score whenever appropriate . the wilcoxon signed rank test was used to compare the difference between the pre and post - operative dysmenorrhea pain scores . the study was conducted in the department of obstetrics and gynecology at chosun university hospital . from july 2008 to july 2013 , 272 reproductive female patients ranging from 32 to 47 years old who suffered midline dysmenorrhea were enrolled in a non - randomized prospective study . one hundred and thirty - two patients were in the lrfm group , 140 patients were in the urfm group . two hundred and seventy - two patients who had undergone surgery were prospectively surveyed regarding dysmenorrhea before and 1 year after rfm . all patients were informed the risks and benefits of laparoscopic rfm . before rfm as well as 1 year after surgery , they all completed a questionnaire that requested information on the severity of dysmenorrhea on a 0 to 4 pain score , which was similar to that devised by chen.8,9 severity of dysmenorrhea in all patients was scored in a 5-point scale ranging from 0 to 4 ( i.e. , 0 = no pain , 1 = mild pain requiring no medication , 2 = moderate pain responding to mild pain relievers , 3 = severe pain necessitating potent pain relievers , and 4 = incapacitating pain unresponsive to potent pain relievers ) . and we treated women whom they do n't want to have a baby anymore ; because of not being proven the relationship between rfm , with pregnancy and side effects . lrfm of uterine myomas was performed under local anes thesia using diazepam ( 20 mg ) and pethidine ( 100 mg ) intravenously . a uterine manipulator was inserted for better exposure of the myomas puncture site to be treated . then , a 2 mm trocar was inserted through an umbilical incision after injection of lidocaine . the rf needle was inserted percutaneously after insufflating co2 gas into the pelvic cavity , and placed within the target myoma under laparoscopic video guidance . the depth of the needle insertion was determined on the basis of a pre - operative ultrasound . the tip of the central prong was placed about 1 - 4 cm beyond the center of the myoma by size , so that the peripheral electrodes were localized where the cross - sectional area of the myoma was largest . the target temperature for rfm was 80. a rf generator ( rf medical , seoul , korea ) automatically adjusts the power to maintain the selected temperature . lrfm group , a video 2 mm laparoscope was inserted via a troca placed through a subumbilical incision . , we filled the pelvic cavity with adept ( baxter , vienna , austria ) and sprayed using a 16 g spinal needle on the region for preventing adhesions after rfm . the laparoscopy equipment was made by karl stortz gmbh & co ( tuttlingen , germany ) . urfm of uterine myomas was performed under local anesthesia using diazepam ( 20 mg ) and pethidine ( 100 mg ) intravenously . in the lithotomy position , urfm group underwent transvaginal insertion of an ultrasonic needle into the center of the myoma(s ) or lesion before myolysis . the diagnostic ultrasound system was made by toshiba nemio ( ssa-550a ; toshiba medical systems corp . , in this study , the students t test , the mann - whitney u test and chi - square test were employed to compare age , operation time , length of hospitalizaton and post - operative dysmenorrhea pain score whenever appropriate . the wilcoxon signed rank test was used to compare the difference between the pre and post - operative dysmenorrhea pain scores . we designed a prospective study and used a zero - to-4 pain score system to evaluate 272 patients before and after rf myolysis . the classification of patients are shown in table 1 for the lrfm and the urfm groups . table 2 shows no significant difference on the hospitalization length and post operative pain score between two groups . the mean length of hospital stay (  standard deviation [ sd ] ) was 1.34  0.27 , 1.53  0.85 , respectively ( p < 0.808 ) . the mean (  sd ) post - operative pain score for dysmenorrhea was 0.83  0.53 ( urfm ) , 0.32  0.78 ( lrfm ) . in all groups , a significant difference was found in terms of pain scores for dysmenorrheal ( p < 0.001 ) before and after rfm . no patient reported a change in the postoperative pain score during follow - up . but the mean operation time was shorter in the urfm group , compared to the lrfm group . only the increased vaginal discharge and abdominal pain were statistically different in the two groups ( p = 0.006 , p = 0.000 ) . previous studies have revealed that presacral neurectomy ( psn ) provides an effective and relatively safe treatment for women with midline dysmenorrheal.10,11,12 an often - ignored procedure is interruption of uterosacral nerves . it was first described by ruggi13 in 1899 , since then european gynecologists have performed it frequently . in 1955 , vaginal transaction of uterosacral nerves provided relief to over 70% of patients.14 these results were similar to those tabulated for psn . the surgical approach of incorporating interruption of the superior hypogastric nerve plexus ( psn ) is less popular.8 laparoscopic surgery has become increasingly popular in recent years and plays an important role in treating patients with dysmenorrheal.15 so , lpsn was shown to be more effective than lpsn in terms of long - term postsurgery pain reduction for midline dysmenorrhea after 12 months . but the presacral area is abundant in blood vessels and variables in nerve anatomy , complications could happen during and after lpsn . several new techniques for myolysis have been sought in an attempt to achieve minimally invasive approaches to uterine myomas which are less technically demanding , and less time consuming than laparoscopic myomectomy , while minimizing adhesion formation.16 even though laparoscopic or open myomectomy are considered the classic surgical approaches for women who desire uterine preservation , the current literature on this subject underlines the need for new , alternative , less invasive techniques to treat symptomatic myomas . myolysis as a treatment option for uterine myomas was first introduced in the late 1980s as a hysteroscopic technique.17 subsequently , myolysis was performed as a variation on the technique of laparoscopic myomectomy in which myomas are coagulated rather than removed . the rf uterine myolysis procedure provides an alternative for those patients who suffer intractable midline dysmenorrheal . this procedure is relatively simple and safe and could result in a satisfactory outcome in the intervention of midline dysmenorrheal . we designed a prospective study and used a zero - to-4 pain score system to evaluate 272 patients before and after rfm . we conclude that dysmenorrheal statistically significantly improved after rfm in women with symptomatic uterine myomas . rf energy desiccate target tissue directly of disrupt their blood supply and destroy pain receptors in nerve fibers in the uterus . therefore lrfm may provide a better operative field and complete resection in comparison to urfm . when a patient requires surgical treatment for chronic midline pelvic pain or severe dysmenorrhea , lrfm is an al ternative choice . lrfm is an alternative choice because it is relatively safe and , simple to perform and moreover , it is satisfactory . a larger series of patients and precise methodology , including a more detailed pain score system of inclusion criteria , nonetheless , are necessary to fully evaluate the efficacy of the lrfm procedure .
objectivesto access the effectiveness of radiofrequency myolysis ( rfm ) in women with midline dysmenorrhea.methodswe designed rfm in two ways laparoscopic rfm ( lrfm ) , vaginal ultrasound - guided rfm ( urfm ) . 
 one hundred and thirty - two patients were in the lrfm group and , 140 patients were in the urfm group.resultsupon receipt of surgery , both the lrfm and the urfm groups demonstrated a significant decrease ( p < 0.001 ) in the mean pain score when compared to those before and after surgery.conclusionthe rf uterine myolysis procedure provides an alternative for those patients who suffer from intractable midline dysmenorrhea . 
 lrfm is an alternative choice because it is relatively safe and , simple to perform and moreover , it is satisfactory . 
 lrfm appears to increasingly succeed in the treatment of midline dysmenorrhea .