Endometrial thermal balloon ablation under local anesthesia in patients with prosthetic heart valves: a pilot study

We treated eleven cases of high risk surgical candidate women with prosthetic heart valves, complaining of menorrhagia, by thermal balloon ablation under local anesthesia after pharmacological endometrial thinning. Menorrhagia was documented by a validated pad scoring system. All patients were severely anemic at presentation. Nine of them had one valve replaced among these cases, two were restenosic at presentation, one had twice mitral valve replacement. Two of them had two valves replaced. All procedures were performed under local anesthesia supplemented by analgesics, no complications were observed either intraoperatively or during the follow-up of at least 24 months. After two years, thermal balloon ablation proved to be statistically significantly effective in terms of pad score reduction; two patients reported spotting and the rest was hypomenorrheic, none of the group experienced amenorrhea. This technique proved to be safe, feasible and effective under this clinical circumstances.     

Thermal balloon ablation in myoma-induced menorrhagia under local anesthesia

OBJECTIVE: Our purposes were to compare the impact of surgery on menstrual blood flow reduction and on the increase in hemoglobin values as primary endpoints at 12 months, and operating time, complication rates, postoperative pain scores at 12 h and surgically induced amenorrhea rates at 12 months as secondary endpoints after roller ball endometrial ablation or thermal balloon ablation for myoma-induced menorrhagia. MATERIALS AND METHODS: Menorrhagic women (documented by a validated pad scoring system) over 40 years of age, with a mobile myomatous uterus smaller than 12-week pregnancy, were enrolled in a prospective randomized trial to compare endometrial roller ball ablation and thermal balloon ablation after pharmacological endometrial thinning. One year after surgery, primary and secondary endpoints in both groups were compared. RESULTS: Forty-five subjects underwent endometrial thermal balloon ablation under local anesthesia and 48 underwent endometrial roller ball ablation under general anesthesia. Statistically significant but similar decreases in mean pictorial blood assessment score and increases in mean hemoglobin values were noted for both groups at 12 months. Those who underwent endometrial roller ball ablation had experienced significantly more intraoperative complications. CONCLUSION: Thermal balloon ablation under local anesthesia for myoma-induced menor- rhagia provided both significant and statistically similar reductions in menstrual blood flow and increases in hemoglobin values with no intraoperative complication compared to roller ball endometrial ablation.     

Endometrial ablation with a new thermal balloon system

STUDY OBJECTIVE: To assess the efficacy of Thermablate EAS, a new, simple, hand-held, portable endometrial ablation instrument, in the treatment of menorrhagia. DESIGN: Retrospective observational study (Canadian Task Force classification II-1). SETTING: Urban hospital and private clinic facilities in Bombay, India. PATIENTS: Sixteen women with menorrhagia. INTERVENTION: Endometrial ablation with the Thermablate EAS. MEASUREMENTS AND MAIN RESULTS: Follow-up at 6 months showed eight patients (50%) to have amenorrhea and six (38%) hypomenorrhea. The only failure was in a patient with cystic hyperplasia. No complications occurred. CONCLUSIONS: Thermablate EAS is a promising instrument for endometrial ablation.     

Endometrial ablation with a thermal balloon: the first 10 years

Thermal balloon endometrial ablation (BEA) was introduced approximately 10 years ago as the first automated replacement for hysteroscopic endometrial ablation (HEA) in women with chronic abnormal uterine bleeding. Putative advantages included similar or improved clinical outcomes, and reduction of both adverse outcomes and the total cost of care, all with reduced requirements for operator skill. The published literature contains 1191 cases of BEA performed with instruments from 4 manufacturers, including a number of randomized clinical trials (RCTs) comparing the devices with HEA, usually performed by experts. In comparative RCTs, clinical and health-related quality of life outcomes as well as patient satisfaction and rate of subsequent uterine surgery appear similar in follow-up intervals that ranged from 1 to 5 years. There is a suggestion of reduced risk of adverse events with BEA, but the differences are small. There are no rigorous evaluations of resource use. The level of surgeon expertise in HEA arms of available RCTs potentially improves quality and decreases complications over what might be expected in the general population. Thus BEA seems equivalent to HEA when performed by expert surgeons with respect to most outcomes. Effectiveness studies of the two interventions should be conducted in community settings and should evaluate resource use.     

Endometrial ablation by rollerball electrocoagulation compared to uterine balloon thermal ablation. Technical and safety aspects

Objective: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal (UBT) ablation (Thermachoice™), regarding intra- and post-operative technical complications and safety aspects. Study design: A randomised controlled study in a teaching hospital, 139 pre-menopausal women with dysfunctional uterine bleeding proved by a validated menstrual score list were enclosed. Endometrial ablation by a hysteroscopic or non-hysteroscopic method was performed. Results: Rollerball electrocoagulation carries a significantly higher risk of intra-operative complications compared to uterine balloon thermal ablation and is a significantly more time consuming procedure. Post-operative complication rates in both groups were low, but post-operative analgesics were prescribed significantly more in the uterine balloon group. Conclusion: Endometrial ablation by uterine balloon thermal ablation (Thermachoice™) is a safe and simple non-hysteroscopic procedure.     

Endometrial ablation

Both YAG ablation and resectoscopic ablation of the endometrial cavity produce good results in most patients. Most hysteroscopic surgeons choose the resectoscope because it is much faster and easier and the results are comparable or better. Newer, larger YAG fibers may make a great difference in technical ease and speed. These new series are just beginning.     

Endometrial ablation

PURPOSE OF REVIEW: Although endometrial ablation has now been accepted practice for more than 20 years, it continues to be a source of research, controversy and speculation. This is illustrated by the 175 articles found in PubMed between the years 2000 and 2003 under the search term 'endometrial ablation' commissioned as part of the preparation for this article. RECENT FINDINGS: The so-called first-generation methods (laser, resection, rollerball) have now got long-term follow-up data of up to 20 years. A few of the second-generation devices have published long-term follow-up data of 5 years. All of the second-generation devices assessed in randomized trials with the first-generation methods compare favourably; however, there are few data on cost effectiveness. Similarly, there are few data comparing endometrial ablation with the Mirena intrauterine device. SUMMARY: Conventional endometrial ablation has been extensively validated; however, many of the newer techniques have inadequate patient numbers or lengths of follow-up on which to evaluate their long-term efficacy, safety or cost effectiveness fully. The anticipated decline in hysterectomy rates with the advent of endometrial destruction methods has not occurred, and this may indicate a lower threshold for surgical management.     

Endometrial balloon ablation as a therapy for intractable uterine bleeding in an adolescent.

STUDY OBJECTIVE: To evaluate the use of a minimally invasive global endometrial ablation technique in the management of life-threatening bleeding unresponsive to hormonal treatment. RESULTS: Immediate cessation of bleeding with recovery of normal hematologic profile. CONCLUSIONS: Endometrial ablation by global balloon ablation may be considered an alternative to hysterectomy in life-threatening hemorrhage in the adolescent patient who is unresponsive to hormonal therapy.     

Endometrial thermal balloon ablation with the ThermaChoice system: effect of intrauterine pressure and duration of treatment

STUDY OBJECTIVE: To determine the safety and efficacy of thermal balloon therapy under variable intrauterine pressures and durations of treatment. DESIGN: Retrospective cohort study. (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital. Patients. Sixty-six women with menorrhagia. INTERVENTION: Eighteen patients were treated with the ThermaChoice thermal balloon system for 8 minutes at 80 to 150 mm Hg pressure, 15 were treated for 8 minutes at 151 to 180 mm Hg, and 33 were treated for 12 to 16 minutes at 151 to 180 mm Hg. MEASUREMENTS AND MAIN RESULTS: No intraoperative complications occurred and postoperative morbidity was minimal. At 12 to 24 months follow-up, persistent menorrhagia was reported in 56% of women treated at 80 to 150 mm Hg compared with 20% treated at 151 to 180 mm Hg for 8 minutes (p = 0.01), and in 24% treated for 12 to 16 minutes at 151 to 180 mm Hg (p = 0.1). CONCLUSION: Thermal balloon endometrial ablation is a safe and effective treatment for menorrhagia. Balloon pressure greater than 150 mm Hg increased the effectiveness of treatment. Success was not affected or influenced by increasing the duration of treatment from 8 to 12 minutes or more.     

Endometrial ablation: principles and technique

Uterine bleeding may be caused either by benign organic pathology as well as different dysfunctional conditions. Medical treatment with progestins, danazol or GnRH analogues is usually used as the first choice therapy. Where the symptoms persist, hysterectomy is generally proposed; it has been calculated that from 500,000 to 700,000 such operations are performed annually in the United States. The authors review the state of the art of the endometrial ablation as an alternative to hysterectomy and other medical therapy. Endometrial ablation either by means of the YAG-laser or with the resectoscope, would seem to play a role in well-selected cases of dysfunctional uterine bleeding. In the authors opinion a multicenter study on large numbers of patients is needed in order to confirm these preliminary results.     

Endometrial ablation: postoperative complications

Endometrial ablation as a treatment for abnormal uterine bleeding has evolved considerably over the past several decades. Postoperative complications include the following: (1) pregnancy after endometrial ablation; (2) pain-related obstructed menses (hematometra, postablation tubal sterilization syndrome); (3) failure to control menses (repeat ablation, hysterectomy); (4) risk from preexisting conditions (endometrial neoplasia, cesarean section); and (5) infection. Physicians performing endometrial ablation should be aware of postoperative complications and be able to diagnose and provide treatment for these conditions.