Hysteroscopic Endometrial Resection Sterilization (HERS): Complete Endometrial Resection for Permanent Transcervical Sterilization

Abstract

<h3>Study Objective</h3> To discuss the concept of hysteroscopic complete resection of the endometrium for permanent transcervical sterilization. <h3>Design</h3> Retrospective review for women ≤ 45 undergoing complete resection of the endometrium. <h3>Setting</h3> Minimally Invasive Gynecologic Surgery private practice. <h3>Patients or Participants</h3> Endometrial resection ablation (ERA) has been offered as a treatment for heavy menstrual bleeding (HMB) at AWHI since 1994. It became apparent ERA results in complete obliteration of the cavity after myometrial fusion, which takes 4-6 months. As a result, women were counseled they could rely on ERA for permanent sterilization after that time. We have offered HERS to women without HMB for over 20 years. <h3>Interventions</h3> Complete resection of the endometrium to 6-8 mm myometrial depth using an operative hysteroscope and wire resecting loop, from interstitial portion of tubes to mid-cervical canal. Many, but not all patients were pretreated to reduce endometrial thickness. <h3>Measurements and Main Results</h3> The AWHI database was queried and 356 patients were identified. It is assumed an unanticipated pregnancy following ERA would be reported, since litigation would likely ensue. To date, no pregnancies have been recorded. <h3>Conclusion</h3> ERA is an established procedure for HMB which results in complete obliteration of the cavity and amenorrhea with no foreign body left in place. HERS can be offered to women without HMB for permanent transcervical sterilization.