Endometrial ablation

The endometrial ablation (. Ἔνδον from Greek = endos (inside), AltGr μέτρα = metra (womb) and ablatio Latin - erosion, detachment) is a medical procedure for the removal and / or destruction of the endometrium in dysfunctional bleeding ( Menorrhagia, menorrhagia ). It helps avoid a hysterectomy when hormonal treatments are not possible or have failed. The surgery is usually performed on an outpatient basis.

Indications

An endometrial ablation is medically contribute to strong, appear to be frequent and irregular menstrual periods that are hormonally untreatable and not caused by submucosal fibroids or polyps of the endometrium. Family planning should be completed, a malignant disease of the uterine lining ( endometrial cancer) and their precursors must be excluded. This requires a histological examination of the endometrium by curettage, possibly combined with a hysteroscopy. The method is a way to avoid the removal of the uterus in patients with high surgical and anesthetic risk, or rejection of a hysterectomy.

Method

There are different methods whose basic principle, however, is the same. The lining of the uterus is obliterated or removed down to the muscles. This means that no new lining of the uterus can build up in the monthly cycle. As a result, the menstrual cycle or is reduced back to normal levels. The methods are divided into methods of 1st and 2nd generation.

The methods of the first generation differ principally in those of the second generation, that in the latter the entire mucosa is treated simultaneously and homogeneously. In addition, they are easier to learn and use less experience ahead.

1st generation methods

For the 1st generation process instruments are introduced at a hysteroscopy and endometrial away with an electrical loop, removed via laser, or obliterated by means of electric current or microwaves.

  • Endometrial ablation by ablation and sclerotherapy ( coagulation):

Electrical Koagulationswalze

Worn and desolate endometrium

In the hysteroscopic resection large mucosal areas with an electrical loop to be ablated layer by layer and it included the superficial Myometriumschicht. Means rollerball or a similar electrode is used alone or additionally thermally obliterates the endometrium. Characterized and mucosal areas in the vicinity of the entrance to the fallopian tube can be reliably achieved. Following recommendations of the Working Group Gynaecological Endoscopy of the German Society of Gynecology and Obstetrics However, hysteroscopic ablation of the mucosa with an electrical loop in combination with the obliteration by roller ball or roller is currently standard. Advantage of this method is that intrauterine septa, uterine fibroids and polyps can be removed in the same session.

  • Nd: YAG laser: A hysteroscopic ablation of the endometrium endometrium with the laser is not widespread. In this method, the mucous membrane is also thermally desolate.
  • Mikrowellenkoagulation: The thermal obliteration of the endometrium by use of microwaves is used primarily in the countries of the Commonwealth, where it has been also developed.

2nd generation methods

  • Uterine balloon method: a balloon catheter is inserted into the uterus, and the balloon filled with hot water during the procedure. Depending on the method the uterine cavity 8 is heated to 15 minutes and destroys the uterine lining so.
  • Hydrothermablation: In the hydrothermal ablation circulates 90 ° C hot saline through the uterine cavity, leading to obliteration of the mucosa.
  • Cryotherapy: The obliteration of the mucosa is achieved here by cold application via a probe.
  • Bipolar three-dimensional network: Also referred to as Gold Network Method method uses a three-dimensional network, which is expanded in the uterine cavity. The obliteration of the endometrium is happening here on electrical heat energy.

Success rate

The convalescence after endometrial ablation is between one day and two weeks. Endometrial heals with scarring, resulting in amenorrhea ( in about 40% of patients) or a reduction in the bleeding intensity. The hormonal cycle is not, menstrual pain usually influenced.

A complete failure of the method, the absence of any improvement in symptoms is rare and is reported in only 5%. However, at about 20 % of the treated women, a second engagement or hysterectomy is necessary. To improve the success rate may be useful pharmacological pre-treatment with progestins or GnRH analogues.

The endometrial ablation is not suitable as a form of contraception. Since the mucous membrane can never be completely removed or destroyed, the training of endometrial cancer is possible in rare cases.

Alternatives

As possible alternatives to endometrial ablation, various hormonal treatment measures, in particular the IUS available. Wishes the woman a 100% bleeding freedom is preferable to have a hysterectomy.

Risks

Complications are frequent in endometrial ablation rare, but can be very serious:

  • Perforation of the uterine wall
  • Pulmonary edema
  • Injury to adjacent organs
  • Post- ablation syndrome
  • Placenta accreta in cases of pregnancy
  • Pulmonary embolism

History

The endometrial ablation was developed in 1979 by the American gynecologist Milton H. Gold Rath, who first with a Nd: YAG laser performed.

In utero IUD with progestogen Asherman's syndrome Digital Object Identifier
308072
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