Swimming lessons—Check the water before jumping in

Abstract

At the close of the World Congress on Hysteroscopy and Related Technologies in the Management of Abnormal Uterine Bleeding, sponsored by the American Association of Gynecologic Laparoscopists (AAGL), in Miami, Florida, February 27 to March 1, 1998, it is wise to pause and reflect on the present state of endometrial ablation. One might even chance a look into the future. More than 40 invited international faculty members, all experts in operative hysteroscopy and endometrial ablation techniques, made formal presentations at the World Congress. Another 50 scientific papers and video tapes made up the free communications portion of the program. The AAGL, both in its educational programs and in its journal, has taken the lead in responsibly disseminating information regarding new technologies that offer women alternatives to hysterectomy in the management of abnormal uterine bleeding. In the past 2 years the journal published more than 40 articles or abstracts on operative hysteroscopy and endometrial ablation. This month, a paper by Martyn and Allan reports on longterm outcomes in 301 patients undergoing endometrial ablation for treatment of menorrhagia. Despite the association's concerted and serious effort to spread the word, sizable numbers of physicians remain inextricably wed to the outdated notions that dilatation and curettage is a reliable diagnostic and therapeutic procedure, and that removing the uterus is the only legitimate procedure for women seeking surgical management of this disorder. It is understandable, however, that many physicians were hesitant to dive headlong into uncertain waters surrounding early attempts at endometrial ablation. With initial published reports, first with the neodymium:yttrium-aluminum-garnet laser and operating hysteroscope in 1981, l and later with electrical energy and a modified urologic resectoscope in 1983, 2 concerns were expressed regarding serious complications 3 and uncertain treatment success. Physicians performing endometrial ablation quickly became aware