Partial Resectoscopic Endometrial Ablation As a Viable Alternative to Global Ablation: A Case Series and Demonstration

Abstract

Study Objective In the past decade, recognition of late onset endometrial ablation failures - generally resulting from intra-uterine scarring around residual or recovered endometrium - has increased interest in alternative treatments for heavy menstrual bleeding, such as partial ablation. This video presents the history of this uncommon procedure, a case series, and a demonstration of our preferred technique. Design This retrospective case series illustrates operative indications and limited outcomes with an average of 1.4 years of follow-up. The surgical video demonstrates principles for a safe and effective procedure. Setting Minimally invasive gynecologic sub-specialty group within a suburban community teaching hospital system. Patients or Participants From 2010-2019, 11 of 132 (8%) patients identified by billing procedure codes met inclusion criteria that a partial endometrial ablation was performed for heavy menstrual bleeding. Interventions A 9mm bipolar resectoscope was used to remove 50-65% of the endometrium and superficial myometrium (at least 4mm depth), including the anterior or posterior surface and the lateral walls. Any concomitant focal pathology was also removed. Measurements and Main Results Seven of 11 patients were 45 years old or younger. All patients declined or failed hormonal therapies and declined hysterectomy. Operative time averaged 45 minutes. There were no intraoperative or postoperative complications. Of 9 patients with at least 1 year of follow-up, 6 reported eumenorrhea. Ultimately 3 of 11 patients underwent or desired hysterectomy to date. Conclusion This video reviews the limited literature and one center's experience with partial resectoscopic endometrial ablation as an alternative to global ablation and includes a demonstration of proper technique. In the past decade, recognition of late onset endometrial ablation failures - generally resulting from intra-uterine scarring around residual or recovered endometrium - has increased interest in alternative treatments for heavy menstrual bleeding, such as partial ablation. This video presents the history of this uncommon procedure, a case series, and a demonstration of our preferred technique. This retrospective case series illustrates operative indications and limited outcomes with an average of 1.4 years of follow-up. The surgical video demonstrates principles for a safe and effective procedure. Minimally invasive gynecologic sub-specialty group within a suburban community teaching hospital system. From 2010-2019, 11 of 132 (8%) patients identified by billing procedure codes met inclusion criteria that a partial endometrial ablation was performed for heavy menstrual bleeding. A 9mm bipolar resectoscope was used to remove 50-65% of the endometrium and superficial myometrium (at least 4mm depth), including the anterior or posterior surface and the lateral walls. Any concomitant focal pathology was also removed. Seven of 11 patients were 45 years old or younger. All patients declined or failed hormonal therapies and declined hysterectomy. Operative time averaged 45 minutes. There were no intraoperative or postoperative complications. Of 9 patients with at least 1 year of follow-up, 6 reported eumenorrhea. Ultimately 3 of 11 patients underwent or desired hysterectomy to date. This video reviews the limited literature and one center's experience with partial resectoscopic endometrial ablation as an alternative to global ablation and includes a demonstration of proper technique.