#81 Endometrial Ablation Flashcards
Who is a candidate for endometrial ablation?
Premenopausal women with HMB, normal uterine cavity, and no future fertility desired
What is the bleeding pattern patients should expect after endometrial ablation?
Range from Normalization of periods to amenorrhea (not achieved in substantial number of cases)
Is endometrial ablation a sterilization procedure?
No. Patients should be counseled about effective contraception due to risk of becoming pregnant
What pre operative work up needs to be done for endometrial ablation
Endometrial sampling to rule out hyperplasia/malignancy.
Assessment of cavity architecture with TVUS, SIS, and/or HSC.
What type of energy is used in the resectoscope?
Radio frequency alternating current
Besides energy, what other methods of endometrial ablation are there?
Cryotherapy, heated free fluid, microwave, thermal balloon
What type of energy is used in the Novasure system?
Radio frequency electricity
For HMB, is medical treatment better/worse/same compared to endometrial ablation?
higher satisfaction with ablation vs oral therapy. No difference in quality of life at 1 yr with Mirena vs ablation although ablation better at controlling bleeding at 1 yr. however no difference in bleeding at yrs 2-3y
How does suppression of endometrial proliferation affect resectoscopic ablation of endometrium?
Pre op danazol of GnRH agonist results in shorter procedure, greater ease of surgery, lower rate of post op dysmenorrhea, higher rate of post surgical amenorrhea (short term, unknown about long term effect). No data available to assess use of pre op systemic progesterone or mechanical preparation of lining (D&C)
To what depth do non resectoscope systems treat (apart from Novasure)?
About 4-6mm
How thick is a typical endometrium during luteal phase? Single layer
6mm. More for women with annovulation
Standard radiofrequency electrosurgical operative hysteroscopy or resectoscopy with monopolar instrumentation requires what kind of distention media?
electrolyte-free, low-viscosity solutions, such as 3% sorbitol, 1.5% glycine, 5% mannitol, and combined solutions of sorbitol and mannitol
What are risks of electrolyte free distention media during hysteroscopy?
Dilutional hyponatremia And hypoosmolality (except mannitol), which can lead to cerebral edema.
Why are premenopausal women more at risk of cerebral edema with absorption of electrolyte free solution during hysteroscopy?
Estrogen and progesterone inhibit the brain’s sodium pump
How can you decrease the amount of systemic intravasation of hysteroscopic distention media?
Pre op GnRH analogues or immediate pre op use of intracervical dilute vasopressin. Using lowest effective intrauterine pressure. Avoid pre op overhydration
Which method of endoscopic ablation is most associated with cervical lacerations and uterine perforation?
Resectoscopic endometrial ablation
If uterus is perforated with active electrode during resectoscope procedure, what is mandatory?
Exploration of peritoneal cavity. Laparotomy vs laparoscopy
What is postablation tubal ligation syndrome?
Cyclic pain in a women s/p endometrial ablation who previously had tubal ligation surgery, thought to be due to remaining endometrium in cornua
What is the treatment for postablative tubal ligation syndrome?
Hysterectomy appears to be most effective therapy.
What are the obstetric risks if a patient get pregnant after endometrial ablation?
high rates of malpresentation, prematurity, placenta accreta, and perinatal mortality.
Is there a delay in diagnosis of endometrial cancer after endometrial ablation?
Does not appear to be. It seems that most women retain an intrauterine cavity to allow egress of postmenopausal bleeding.
Relative and absolute contraindications to endometrial ablation?
women with endometrial cavities that exceed device limitations. procedure should not be performed with recent pregnancy or in the presence of active or recent uterine infection, endometrial malignancy, or hyperplasia.
