Hysteroscopic endometrial ablation using the Hydro ThermAblator in an outpatient hysteroscopy clinic: feasibility and acceptability

STUDY OBJECTIVE: To assess the feasibility and patient acceptability of global endometrial ablation using the Hydro ThermAblator (HTA) in an outpatient hysteroscopy clinic setting under local anaesthesia. DESIGN: A prospective cohort study (Canadian Task Force classification II-2). SETTING: University hospital in the United Kingdom. PATIENTS: Forty patients with medication-resistant menorrhagia. INTERVENTION: Oral mefenamic acid was administered 8 hours before the procedure. A combined cervical/paracervical block using lignocaine 1% adrenaline 1:200,000 was used before hysteroscopic endometrial ablation using the HTA device. MEASUREMENTS AND MAIN RESULTS: A successful procedure was defined as a completed HTA treatment cycle. Failure was defined as premature termination or inability to carry out the HTA procedure after scheduling the patient. Pain scores were estimated at three stages during and after the procedure using a visual-analog scale. A questionnaire was used before discharge to assess acceptability. Forty patients were successfully treated. The median pain score during the ablation was 6.4 (range 4.0-8.9). Eighty-eight percent of patients found the procedure acceptable. No serious complications occurred. All patients were discharged home within 2 hours of the procedure. CONCLUSION: Selected patients suffering from menorrhagia may be treated with the HTA device using local anesthesia in an outpatient setting.