Endometrial Ablation

<Surgery>

<Index>

 

 

Definition

-  Surgical destruction of uterine lining (endometrium) down to the level of basalis (4-6mm deep depending on stage of cycle)

 

Features

-  Nonresectoscopic (global or 2nd generation) or resectoscopic (with hysteroscope, standard or 1st generation)

-  Minimally invasive day procedure

-  Nonresectoscopic: bipolar radiofrequency, hot liquid filled balloon, cryotherapy, circulating hot water, microwave

-  Hysteroscopic: rollerball, wire loop, vaporising electrode, laser

-  Menorrhagia may indicate endometrial hyperplasia or Ca, contraindications to ablation, therefore endometrial sampling should be performed prior to ablation

-  Does not prevent pregnancy

-  Increasingly popular

 

Indications

-  Acute abnormal uterine bleeding in haemodynaimcally stable women not suitable for medical therapy

-  Ovulatory menorrhagia in premenopausal women

 

Procedure

-  Pre-op

-  Endometrial sampling prior to ablation

-  Endometrial imaging to exclude myomas, polyps or other uterine pathology or abnormalities (Hysteroscopy or Saline infusion sonography (SIS))

-  +/- Hormonal suppression to thin endometrium for 30-60/7 (GnRH agonist)

-  May be performed hysteroscopically or non-resectocopically (more common)

-  Antibiotic prophylaxis not routine

-  Regional anaesthesia or GA

 

Complications

-  Post-op

-  Irregular bleeding for 8-12 weeks

-  Amenorrhoea 38%+/- at 1yr, 2-5yrs 50%+/-

-  Uterine perforation

-  0.3% non-resectoscopic

-  1.3% resectoscopic

-  Haemorrhage: non 1.2%, scope 3%

-  Haematometra: non 0.9%, scope 2.4%

-  Pelvic infection (PID..): 1-2%

 

Precuation/Contraindications

-  Endometrial hyperplasia or Ca: interferes with investigations (adhesions & histology changes)

-  Women wishing to preserve fertility

-  Not recommended post menopausal: does not allow for subsequent exclusion of Ca

-  Precaution in women with septate or unicornuate uteri