Hysteroscopic Endometrial Ablation Is an Effective Alternative to Hysterectomy in Women with Menorrhagia and Large Uteri

King Abdulaziz University, Djidda, Makkah, Saudi Arabia
The Journal of the American Association of Gynecologic Laparoscopists (Impact Factor: 1.61). 08/2000; 7(3):339-45. DOI: 10.1016/S1074-3804(05)60476-8
Source: PubMed


To examine the feasibility, safety, and outcome of hysteroscopic endometrial ablation, and to determine the volume of fluid absorbed during resection versus rollerball coagulation in women with menorrhagia and large uteri.
Retrospective review (Canadian Task Force classification II-2).
University-affiliated teaching hospital.
Forty-two consecutive patients (mean +/- SD age 45.6 +/- 6 yrs) with uterine size greater than 12 weeks (cavity >12 cm). Intervention. Endometrial ablation; 26 (62%) women were pretreated to thin the endometrium.
Resection was performed in 27 patients (65%) and rollerball coagulation in 15 (35%). Ablation was successfully performed in all patients in a day surgery setting. Multiple regression analysis examined the relationship of uterine size, pretreatment, procedure, and duration of surgery to amount of glycine absorbed. Glycine absorption was higher with resection than with coagulation (p = 0.04). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.04) but not with duration of the procedure, uterine size, or pretreatment. One patient with uterine fibroids and one with endometrial adenocarcinoma had hysterectomy. With follow-up of 39 (95%) of 41 women (excluding the one with adenocarcinoma) for 14 +/- 2 months, 38 (93%) were very satisfied. Thirty (73%) had amenorrhea, six (15%) had hypomenorrhea (<3 pads/day), and three (7%) had eumenorrhea (<10 pads/day).
Hysteroscopic endometrial ablation may be a feasible, safe, and effective alternative to hysterectomy in women with menorrhagia and large uteri.

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Available from: Mamdoh Eskandar, Dec 24, 2013
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    ABSTRACT: Surgical management of AUB is in a process of evolution, from one in which hysterectomy was the only option, to one in which there exist a panoply of approaches, each of which has differing risks, costs, clinical outcomes, and appropriateness for a given woman. These options have arrived concomitant with another, more revolutionary process, as women with disorders that affect lifestyle are transitioning themselves from passive patients who are "managed" by physicians, to involved health care consumers who demand partnership in the collaborative effort designed to determine what, if any procedure best fits their needs. Clearly, more high-quality clinical research is necessary to answer more adequately valid questions posed by women regarding sexuality, pregnancy, complications, functional outcomes, and total cost associated with these procedures as well as outcomes that we, at the present time, might not even imagine. Nevertheless, the contemporary gynecologic health care provider is charged with keeping abreast of a greater breadth and depth of knowledge when approaching the woman with AUB in the reproductive years than ever before. And those who fail to acquaint themselves with the management options and relevant evidence are liable to render themselves as obsolete as the horse and carriage, the typewriter, or even the DOS computer operating system. Not all gynecologists will be able, for various reasons, to acquire skill in all procedures designed to treat AUB; UAE being the most obvious example. However, skill intensive procedures such as hysteroscopic endometrial ablation may well be replaced by one or more of the NHEA devices that appear to require minimal training and experience for effective outcomes. Furthermore, older operations such as supracervical hysterectomy and newly packaged devices such as progestin-impregnated intrauterine devices may each find a particular niche in management of appropriately selected women with AUB. With availability of so many surgical and medical therapeutic options, it is incumbent upon the gynecologist to understand the pathogenesis of AUB and methods for evaluation of women discussed in the first installment of this series. This will allow affected women the best opportunity to select the approach most appropriate for them, be it one or more of the medical options discussed in the second installment, or a procedural intervention such as those reviewed above.
    No preview · Article · Feb 2001 · The Journal of the American Association of Gynecologic Laparoscopists
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    ABSTRACT: Dysfunctional uterine bleeding occurs during the reproductive years unrelated to structural uterine abnormalities. Ovulatory dysfunctional uterine bleeding occurs secondary to defects in local endometrial hemostasis; while anovulatory dysfunctional uterine bleeding is a systemic disorder, occurring secondary to endocrinologic, neurochemical, or pharmacologic mechanisms. Evaluation of patients with abnormal uterine bleeding and identifying those with dysfunctional uterine bleeding is achieved with a combination of the following: history; physical examination; and judicious use of laboratory evaluation, endometrial sampling and uterine imaging, with sonographic techniques and/or hysteroscopy. Coagulopathies should be considered as should the notion that intramural and subserosal myomas are unlikely to contribute to AUB. High-quality evidence suggests that medical therapy is frequently successful, and newer approaches, such as local delivery of progestins via intrauterine devices, appear to be particularly promising and devoid of systemic side effects. For those intolerant of medical therapy, and/or for whom fertility is no longer desired, a number of minimally invasive surgical options for hysterectomy now exist and are collectively termed endometrial ablation. Endometrial ablation may be performed with or without hysteroscopic guidance. There is an increasing body of evidence that suggests that nonhysteroscopic endometrial ablation may be at least as effective as hysteroscopic endometrial ablation, even when the hysteroscopic procedure is performed by experts.
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