Thermal endometrial ablation: a simple technique

BACKGROUND: To evaluate the effectiveness and safety of a technique for thermal endometrial ablation. METHOD: The study was carried out in three steps; step I on 10 fresh uterine specimens, step II on 14 intact uteri during hysterectomy and step III in five patients, two weeks prior to hysterectomy. A simple device comprising a Foley catheter No. 14F, a three way cannula and a 20 cc syringe was used for the procedure. The balloon of the catheter was inflated within the uterine cavity with boiling normal saline for 9 minutes. Uterine cavity and serosal temperature was recorded during the procedure. Thermal injury was assessed by gross and histological examination of the specimens. RESULTS: The mean maximum endometrial cavity temperature was 91 degrees C whereas serosal temperatures in steps I and II were 34 degrees C and 35.9 degrees C respectively. None of the balloons ruptured in any of the steps and there were no complications. In 13 of 14 specimens in step II, there was a zone of hyperemia with a depth of 3 to 7 mm. The corresponding histological picture was extensive hemorrhage and fragmentation of glands throughout the endometrium including the cornual regions. Consistent findings were noted in step III in which all but one showed extensive coagulative necrosis of the whole of endometrium with edema of the underlying myometrium. There was a statistically significant positive correlation between the volume of fluid injected and depth of hyperemia. CONCLUSION: This technique could be a simple, effective, inexpensive and safe alternative to hysteroscopic endometrial ablation.