6 Endometrial laser ablation

Abstract

With good techniques endometrial laser ablation can be a safe and effective treatment for dysfunctional uterine bleeding. For effective intrauterine surgery it is important to control the intrauterine environment during the procedure to ensure safe operating conditions. This can best be achieved by using a continuous flow hysteroscope and pressure-controlled fluid infusion pump. The laser energy should be applied with a direct dragging technique to produce a series of parallel furrows. Safe ablation will be achieved if the three golden rules are followed and the laser is activated only when the tip of the fibre is visible, only when it is being drawn towards the operator and only when the fibre is being moved across the endometrial surface. With a high power Nd: YAG laser at 80 W power, a treatment time of around 20 min should be regularly achieved. This approach can control menstrual flow in 90% of cases and result in an overall satisfactory outcome in around 85% of cases. Improved patient selection may further improve these results. These satisfactory results can be achieved with minimum morbidity but the potential for serious complications still exists so these techniques should not be undertaken without adequate training and good equipment.