Endometrial Ablation Techniques Research Articles

First and second-generation endometrial ablation devices: A network meta-analysis

ObjectiveFirst-generation and second-generation endometrial ablation (EA) techniques, along with medical treatment and invasive surgery, are considered successful lines of management for abnormal uterine bleeding (AUB). We set out to determine...

Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis

ABSTRACT A common gynecological problem for approximately 30% of women at reproductive age in European countries is heavy menstrual bleeding (HMB). Although hysterectomy is a highly successful treatment for this benign problem, it also risks serious complications due to its nature as a major operation. Less invasive HMB treatment options include insertion of a levonorgestrel-releasing intrauterine system, medical treatment (such as tranexamic acid and oral contraceptive pill), or endometrial ablation (which aims to destroy endometrial tissue and the superficial myometrium to reduce/stop menstrual bleeding). Endometrial ablation failure may result in the objective outcome of hysterectomy. This meta-analysis and review aimed to assess hysterectomy risk following nonresectoscopic endometrial ablation treatment to improve understanding and HMB patient counseling. Various nonresectoscopic ablation techniques versus their associated hysterectomy rates were investigated, and subgroup analyses were performed. Following a comprehensive and thorough search process of the MEDLINE, CENTRAL, and EMBASE databases, 53 articles ultimately met the inclusion criteria for inclusion in the systematic review. Between 1992 and 2017, in the included studies, 48,071 patients underwent endometrial ablation. A high risk of bias was found in 13 studies (mainly due to selection or reporting bias), whereas 12 studies maintained low risk of bias. However, exclusion of the 13 high-risk studies for a subgroup analysis yielded similar results to the original meta-analysis. Results of the analysis indicated a consistently increasing post–endometrial ablation hysterectomy, with 2% increments annually between 1 and 5 years following the procedure, rising to 4.3% after 1 year and 12.4% after 5 years. In 2 studies, a post–10-year follow-up found a mean hysterectomy rate of 21.3%. Between both various study designs and the different varieties of devices used, no major differences in hysterectomy rates were found, respectively. Limitations of the review include a high risk for heterogeneity found among studies in almost all analyses utilized by this analysis. Publication bias and methodological issues (variation of population size and study type) lent to the heterogeneity. Because of this variation, the authors performed analyses of subgroups with different study designs. In addition, of the 53 studies included, 15 of them included fewer than 50 participants, which was corrected in this analysis via an inverse variance. Overall, the study indicated that hysterectomy risk following endometrial ablation increases from 4.3% at the 1-year mark to 12.4% at the post–5-year mark. Neither differences in nonresectoscopic endometrial ablation techniques nor study design seemed to affect hysterectomy rates. This systematic review's data can be applied to clinical practice and used for counseling patients about hysterectomy risks within 5 years of endometrial ablation.

8580 Comparison of Anesthetic Usage with Different Endometrial Ablation Devices

<h3>Study Objective</h3> To compare the anesthetic requirements associated with the use of different non-resectoscopic endometrial ablation (NREA) techniques. <h3>Design</h3> Retrospective comparative analysis for five marketed NREA devices using the information reported in their FDA approved instructions for use (IFU). "Physician discretion" directed anesthesia data were compared. <h3>Setting</h3> Office and operating room. <h3>Patients or Participants</h3> The Intent to treat population reported in IFU for the clinical studies conducted in support of FDA Premarket approval of five endometrial ablation devices. <h3>Interventions</h3> Endometrial ablation with the Cerene® Cryotherapy Device, Genesys® HTA Endometrial Ablation System, Mara™ Water Vapor Ablation System, Minerva® Endometrial Ablation System, and NovaSure® Impedance Controlled Endometrial Ablation System. <h3>Conclusion</h3> When comparing endometrial ablation modalities, anesthetic requirements should factor into choosing one technique over another, especially when considering an in-office procedure. Based on these data, cryoablation with Cerene was significantly more likely to be performed without IV medications (97%) demonstrating high tolerability for office use, as compared with hyperthermic endometrial ablation devices.

Evaluation of Hysteroscopic Endometrectomy: A Reappraisal

Endometrial ablation can be performed using a variety of techniques, including resectoscopic or non-resectoscopic approaches. In this study, we compared 2 resectoscopic endometrial ablation techniques. The first technique was rollerball coagulation followed by endometrectomy (type A; n = 103), and the second was the reverse (type B; n = 107). Besides excessive bleeding in 4 cases, the procedures were uneventful in both groups of patients. We did not encounter uterine perforation or cervical laceration. Satisfaction rates were 97% and 99% with an overall hysterectomy rate of 2.9%. These results compared favorably with those in the literature. The results of our study show that hysteroscopic endometrectomy is effective with few associated complications.

Endometrial ablation techniques in treating menorrhagia.

Menorrhagia is a frequent gynecological problem that is clinically described as excessive blood loss of 80 mL per menstrual cycle. It has the potential to lower their quality of life and to induce anemia. Medical therapy has typically been the first line of treatment; however, it is frequently ineffectual. Hysterectomy, on the other hand, is clearly 100 percent effective in stopping bleeding, but it is more expensive and can cause serious problems. So, the endometrial ablation is preferred when the endometrial layer is destroyed or removed during the procedure. To "ablate" (remove) the endometrial lining, a variety of procedures has been devised. The gold standard resectoscopic procedures (laser, transcervical endometrial resection, and rollerball) require hysteroscopic visualization of the uterus and while safe, necessitate expert surgeons. Several innovative procedures have lately been developed, the majority of which may be conducted blindly and take less time. Many nonresectoscopic procedures are still in the process of being developed, refined, and investigated. This article discusses the various techniques and procedures used in endometrial ablation, the importance of the physician using endometrial thinning agents because success rates are higher when thinning agents are used, and the importance of women understanding the complications mainly related to pregnancy. Women should be helped to make informed management decisions by discussing the risks and benefits of each treatment with their consultant. Since there are many treatment options available, with no one option being superior in all respects, patient preference and treatment preferences should be considered when deciding on management.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Tips and tricks for a successful rollerball endometrial ablation

In this video, we demonstrate how to develop or improve skills in performing rollerball endometrial ablation by describing a step by step guide for the rollerball ablation procedure and demonstrating tips and tricks to maximize the likelihood of an efficient and effective procedure. Today, most endometrial ablations are performed using global techniques. However, there are patients who are not candidates for global techniques because of uterine anatomy or intracavitary pathology. It is important for gynecologic surgeons to have the skills to perform traditional rollerball endometrial ablation to most effectively treat our patients with abnormal uterine bleeding (AUB). Rollerball endometrial ablation is a form of first-generation endometrial ablation performed under hysteroscopic visualization. In trained hands, rollerball endometrial ablation matches or exceeds the effectiveness of global endometrial ablation techniques. Rollerball endometrial ablation is an effective tool for gynecologists to treat AUB. Global endometrial techniques are very effective at treating AUB, however, there are uteri that are not conducive to global techniques. Therefore, there will always be a role for rollerball endometrial ablation. It is imperative that gynecologic surgeons have the skillset to perform this procedure efficiently and effectively.

Modified Thermal Balloon Endometrial Ablation for Treatment of Heavy Menstrual Bleeding.

Objectives:The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB).Materials and Methods:Twelve patients with HMB aged 35–55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. The procedure was undertaken in the operation theater under general anesthesia/intravenous sedation. Three cycles of modified thermal balloon ablation using Foley's catheter were performed to ablate the endometrium. The time given to each cycle was 7 min. All the cycles were performed in the same setting. The main outcome measures that were studied were reduction in the menstrual flow, the need for further treatment, and relief of dysmenorrhea if present. Outcome measure regarding reduction in menstrual flow was statistically analyzed using Fisher's exact test. Statistical significance was determined at a level of P < 0.05.Results:Eighty-two percent of patients experienced a reasonable reduction in menstrual blood flow at 3-month follow-up. Eighteen percent observed no change in bleeding pattern and needed further treatment after failure of the procedure. Forty-two percent of patients complained of minor side effects such as cramp lower abdominal pain and fever. Rupture of balloon during the procedure occurred in only one case (8%).Conclusion:Modified thermal balloon ablation with Foley's catheter can be a promising management of HMB in resource-poor settings. It is a cost-effective alternative to the original endometrial ablation techniques.

The Cerene Cryoablation Device for the Treatment of Heavy Menstrual Bleeding: 36-Month Outcomes from the Clarity Study

<h3>Study Objective</h3> To evaluate the safety and effectiveness of a novel cryoablation device (<i>Cerene Cryotherapy Device, Channel Medsystems, Berkeley, CA)</i> in premenopausal women with heavy menstrual bleeding (HMB) due to benign causes. <h3>Design</h3> A prospective, multi-center, single-arm, open-label study. <h3>Setting</h3> 8 sites in the USA, 1 in Mexico, 2 in Canada. <h3>Patients or Participants</h3> 242 Intent-to-Treat women, 25 to 50 years of age, with HMB, uterine sound ≤10 cm, and endometrial cavity between 2.5 to 6.5 cm. <h3>Interventions</h3> The Cerene single-use disposable device, delivered a 2.5-minute cryoablation of the endometrium. Analgesia and local anesthesia were administered per investigator discretion: 97% of subjects received a paracervical block with or without oral medications, 3% IV sedation, and none received general anesthesia. 180 USA treatments were performed in the physician office setting and none in the operating room. Subjects were evaluated through Month 12 and long term at Month 24 and 36. <h3>Measurements and Main Results</h3> 201 women were evaluated at Month 36. 88.6% (178/201) reported amenorrhea, a lighter than normal, or normal period. 91% (182/201) reported no or slight limitations in life activities in their Menorrhagia Impact Quality of Life (QoL) questionnaire. 85% (171/201) reported premenstrual symptoms (PMS) at a low frequency (none, rarely, or sometimes) in their PMS Impact QoL Survey. 84.5% (153/181) of subjects who reported level of satisfaction at the final study visit stated that they were satisfied or very satisfied with their treatment outcome. 7% (17/242) underwent a post ablation intervention for menstrual bleeding. <h3>Conclusion</h3> The Cerene endometrial cryoablation device maintains safety and effectiveness for the treatment of HMB through the long-term study visit at 36 months. It is a global endometrial ablation technique that can be performed consistently in the office setting requiring minimal anesthesia or analgesia.

2887 Hysterectomy after Failed Endometrial Resection and Endometrial Ablation Techniques. Can We Work Out When It is Going to Fail?

Study Objective Heavy Menstrual Bleeding is the most common reason for gynaecological consultation in the United Kingdom. We aimed to identify factors that may contribute to failed ablation/resection of endometrium, to improve future patient selection and counselling. Design Retrospective audit was performed for women who underwent hysterectomy, January 2012 - December 2018, following a Thermablate, NovaSure, or transcervical resection of endometrium (TCRE). Setting Northern Health and Social Care Trust, Northern Ireland. Patients or Participants 85 patients were identified by clinical coding department. Interventions N/A. Measurements and Main Results Mean age at hysterectomy was 43 years, Average body mass index (BMI) was 31.73 kg/m2. 87% underwent a pre-operative pelvic ultrasound scan, of these 32% had fibroids detected. 72% underwent endometrial ablation using Thermablate, 17% NovaSure, 2% Thermablate followed by NovaSure, 2% had Thermablate twice, performed nine months apart, and 7% patients had transcervical resection of the endometrium. 47% had a trial of Mirena IUS prior to ablation. Mean ablation to hysterectomy interval was 23 months. The main indication for hysterectomy was heavy menstrual bleeding (75%), followed by pelvic pain (13%), then both heavy menstrual bleeding and pelvic pain (11%). Mean specimen weight at hysterectomy was 183g. Abnormal pathology was confirmed in 70% of hysterectomy specimens (Fibroids 54%, adenomyosis 14% and combined pathology including fibroids, adenomyosis, simple hyperplasia and endometriosis in 32%. Dysmenorrhoea, parity, previous normal vaginal deliveries/caesarean section, BMI and type of ablation did not reach clinical significance in terms of predictive parameters. Conclusion When ablation/ resection fails our results demonstrated that the pre-operative demographics above were a poor predictor. Associated identified pathologies particularly fibroids and adenomyosis suggests that pre-operative diagnosis of these would be valuable in optimizing patient selection and counselling.

1322 Comparison of Two Endometrial Ablation Techniques

Study Objective To compare the effectiveness of two methods (Novasure and Minerva) of endometrial ablation in a single community private practice. Design Retrospective chart review of all practice patients undergoing Novasure or Minerva endometrial ablation between 2015 and 2018. Minimum follow-up after the procedure was six months. Setting Procedures were all performed at Saddleback Center for Surgery (ambulatory surgery center) under general anesthesia by the physicians of Orange Coast Women's Medical Group. Patients or Participants All ablations performed between 2015 and 2018 were reviewed. 208 total ablations were performed. There were 127 in the Minerva cohort and 81 in the Novasure cohort. Interventions Not Applicable Measurements and Main Results Charts were reviewed for patient age, amenorrhea rates, rate of subsequent hysterectomy, improvement in bleeding, number of procedures performed by each provider, and days of follow up. Key results revealed no significant difference in the rate of amenorrhea in patients undergoing ablation with Minerva 32.3% (41/127) and Novasure 40.7% (33/81), (p=0.21). There was no significant difference in the rate of subsequent hysterectomy, 5.5% in the Minerva group and 9.9% in the Novasure group (p=0.24). There was no significant difference in patients showing improvement in bleeding without amenorrhea, 48.8% in the Minerva group and 44.4% in the Novasure group (p=0.72). There was no significant difference in the total combined amenorrhea and bleeding improvement; 81.1% in the Minerva group and 85.1% in the Novasure group (p= 0.45). Conclusion In our series, there was no significant difference in the Minerva or Novasure endometrial ablation systems in the rate of amenorrhea, subsequent hysterectomy, and overall decrease in bleeding.

Clinical study of percutaneous microwave ablation of uterine myometrium benign lesions

Objective To study the clinical value of percutaneous microwave ablation of uterine myometrium benign lesions. Methods 100 cases of patients with benign lesions of myometrium in our hospital from January 2016 to January 2017 were enrolled in the study. According to the treatment methods, they were divided into observation group (percutaneous microwave ablation, n=50) and control group (uterine artery embolization, n=50). Relevant perioperative indicators, postoperative complications, hemoglobin (Hb), serum carbohydrate antigen 125 (CA125), menstrual status and follow-up results were observed in both groups. Results The operative time and ambulation time were significantly shortened in observation group (P 0.05). After 1 month and 3 months of treatment, the menstrual period, menstrual volume and dysmenorrhea degree score were gradually decreased in the two groups, and the differences within-groups were significant (P<0.05). Compared with the corresponding time points of the control group, the level of each index in the observation group was lower, and there was significant difference between the two groups. At 3 months and 12 months after operation, the level of Hb in the two groups was gradually increased while the serum CA125 concentration was gradually decreased (P<0.05). Compared with the control group at each time point, the level of each index was better in observation group (P<0.05). At 6 months and 12 months after operation, the uterus volume and fibroid volume in the two groups were gradually decreased (P<0.05). Compared with the control group at each time point, the uterus volume and fibroid volume were smaller in observation group (P<0.05). Conclusions Microwave ablation has high safety in the treatment of benign lesions of myometrium, and it has the advantages of few postoperative complications, quick recovery and definite efficacy. Thus it is worthy of clinical promotion. Key words: Leiomyoma; Uterine neoplasms; Adenomyosis; Endometrial ablation techniques

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

Effect of Shengxuening tablets combined with ethinylestradiol and cyproterone acetate on thickness of endometrium and hemoglobin levels in patients with endometrial polyps for transcervical resection of polyp

Objective To investigate the effects of Shengxuening tablets combined with ethinylestradiol and cycloproterone acetate on endometrial thickness and hemoglobin level in patients with endometrial polyps for transcervical resection of polyp. Methods A total of 150 patients with hysteroscopic endometrial polypectomy were randomly divided into three groups, 50 in each group. The control group was treated with hysteroscopy endometrial polyp electrotomy, while the western medicine group was treated with ethinylestradiol and cycloprogesterone acetate tablets on the basis of the control group, and the combined group was treated with Shengxuening tablets on the basis of the western medicine group. The menstrual volume, endometrial thickness and hemoglobin levels were observed before treatment, at 3 month, 6 month and 12 month after treatment, and the clinical efficacy and recurrence during follow-up were evaluated. Results The total effective rate was 98.0% (49/50) in the combined group, 96.0% (48/50) in the western medicine group, 86.0% (43/50) in the control group. The total effective rate in the combined group and the western medicine group was significantly higher than that in the control group (χ2=6.643, P=0.036). The menstrual volume (F=28.096, 49.096, 33.303), endometrial thickness (F=11.214, 20.265, 63.947) in the three groups were significantly different after treatment (P<0.01), and which in the combined group were significantly lower than those in the western medicine group, menstrual volume at 3 6,12 after treatment (t value were 4.747, 2.244, 4.489, P<0.01); endometrial thickness at 3, 6, 12 month after treatment (t value were 3.293, 3.356, 5.293, P<0.01); there were significant differences in hemoglobin levels in the three groups (F=11.002, 8.662, 8.958, P<0.01), and which in the combined group was significantly higher than that in the western medicine group at 3,6,12 month after treatment (t value were 2.722, 2.074, 2.028, P<0.05). During the follow-up period, 2 cases (4.1%) recurred in the combined group, 3 cases (6.3%) recurred in the western medicine group and 9 cases (20.9%) recurred in the control group. The recurrence rate in the combined group or the western medicine group was significantly lower than that in the control group (χ2=6.775, P=0.034). There was no significant difference in the recurrence rate in the combined group and the western medicine group (χ2=0.211, P=0.646). Conclusions The Ethynestradiol and Cyproterone acetate combined with Shengxuening tablets could improve the curative effect, reduce menstrual volume and endometrial thickness, increase hemoglobin level and reduce recurrence rate in patients with endometrial polyps for transcervical resection of polyp. Key words: Endometrial hyperplasia; Endometrial ablation techniques; Hysteroscopes; Hemoglobinometry; Ethinylestradiol and cyproterone acetate tablets; Shengxuening tablets

Endometrial resection and ablation techniques for heavy menstrual bleeding.

Endometrial resection and ablation techniques for heavy menstrual bleeding.

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do different second-generation endometrial ablation techniques compare after at least one year in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

How do first- and second-generation endometrial ablation techniques compare at one year and later in women with heavy menstrual bleeding?

Surgical management of heavy menstrual bleeding: part 1

Key content Heavy menstrual bleeding affects one in five premenopausal women and significantly impairs quality of life. Management options for heavy menstrual bleeding are diverse and include a variety of medical and surgical treatments. Surgical treatment options are endometrial ablation, hysterectomy and myomectomy. Treatment choice for heavy menstrual bleeding should take into account the underlying pathology, the woman's preferences and fertility needs. Learning objectives To review the first‐ and second‐generation endometrial ablation techniques and evaluate the role of outpatient ablation. To discuss efficacy, safety, acceptability and cost‐effectiveness of various ablation techniques for the treatment of heavy menstrual bleeding in premenopausal women. Ethical issues Is it justified to offer endometrial ablation as a first choice surgical option for the management of heavy menstrual bleeding? Would a move to second‐generation ablation techniques result in loss of operative hysteroscopic skills that may be required for treating intrauterine pathology? With the rising trend of women having more than one caesarean section is it safe to use blind global ablative techniques?

Postablation Endometrial Carcinoma.

Background:Many women have undergone both resectoscopic and nonresectoscopic (or global) endometrial ablation (EA) during the past 20 years. These women are now approaching their sixth and seventh decades of life, a time frame in which endometrial carcinoma (EC) is most frequently diagnosed.Database:In several reports, surgeons have expressed concern that endometrial ablation may leave a sequestered island of EC that may escape detection, possibly delaying its diagnosis or causing it to appear at an advanced stage. Others suggest that EA artifact does not hinder the evaluation and treatment planning in the presence of EC. Data bases used are from Medline and PubMed.Discussion:We introduce 6 new cases of postablation endometrial carcinoma (PAEC), 4 of which occurred after the introduction of global endometrial ablation (GEA) techniques. In addition, we examine several key questions regarding the impact of EA on the subsequent development of EC, including the manner in which PAEC presents, the efficacy of traditional diagnostic modalities, the ablation-to-cancer interval, and the stage of PAEC at the time of diagnosis. Finally, we explore the use of reoperative hysteroscopic surgery (RHS) as a diagnostic modality and address the possible role ultrasound surveillance as a screening method for women at risk of EC.