| February 2002 · Vol. 14, No. 2 Surgical Techniques
Endometrial ablation: a look at the newest global procedures
With the recent FDA approval of cryoablation, bipolar desiccation, and hydrothermal ablation, Ob/Gyns have more options for the quick, simple, and effective treatment of menorrhagia.
Keith
Isaacson,
MDDr. Isaacson is director of minimally invasive gynecologic surgery at Massachusetts General Hospital and Newton Wellesley Hospital, and associate professor of OBG at Harvard Medical School in Boston, Mass.
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Key points
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Global ablation methods involve destroying the endometrium using specialized devices that do not require an operative hysteroscope or resectoscope.
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The endometrium should be destroyed or resected to the level of the basalis, which is approximately 4 to 6 mm deep.
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In cryoablation, freezing the tissue causes less pain than the heat energy associated with other ablation devices. The procedure typically takes 10 to 20 minutes.
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Not only is bipolar desiccation quick and simple, no endometrial pretreatment is required because the system allows for consistent depths of ablation regardless of endometrial thickness.
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The advantage of hydrothermal ablation is that the circulating hot saline solution contacts the entire endometrial surface regardless of the shape or size of the cavity.
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Traditionally, physicians have preferred hysterectomy for the treatment of abnormal uterine bleeding not related to endometrial cancer, representing about 20% of the 590,000 hysterectomie performed annually in the United States.1 The advent of standard endometrial ablation, e.g., surgical resection and rollerball desiccation, offered women less radical alternatives to hysterectomy. However, these “classic” methods are considered by some physicians to be technically difficult because they require the use of an operative hysteroscope—and all of its attendant risks. As a result, many Ob/Gyns continued to opt for hysterectomy when given a choice.
Now there are simpler alternatives: global ablation methods, including the newest—cryoablation, bipolar desiccation, and hydrothermal ablation. These procedures involve destroying the endometrium using specialized devices that do not require an operative hysteroscope or resectoscope. The advantage of these methods is that they are simple, rapid procedures that are easier to perform than standard endometrial ablation. Many surgeons who were uncomfortable utilizing the standard resectoscope can offer this treatment option to women with menorrhagia. In fact, it generally takes clinicians only 5 to 10 procedures to become proficient in endometrial ablation.
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