Hysteroscopic endometrial ablation without endometrial preparation

Microwave endometrial ablation for menorrhagia in patients with systemic disorders

OBJECTIVE

To evaluate the effectiveness of microwave endometrial ablation (MEA) in the treatment of menorrhagia in patients with severe systemic disease or medical conditions.

METHODS

Forty-two menorrhagic women undergoing systemic disorders with failure of medical management were treated with MEA under local or general anesthesia, and were followed-up for 1 year.

RESULTS

The women had a mean age of 39.4 years (range, 17-49). The procedure was successfully completed in all patients, and no intraoperative complications occurred. Two cases died of their primary severe medical diseases within 2 months of treatment but these cases were not associated with MEA. Among the remaining 40 patients, 24 (60.0%) had amenorrhea within 12 months. The duration of hospitalization and the amount of blood transfusion were significantly reduced after treatment, and the quality of life of these patients was improved significantly.

CONCLUSIONS

MEA is a safe and effective treatment for the management of severe menorrhagia in patients undergoing systemic illness or severe medical conditions.

Laparoscopic myomectomy for symptomatic uterine myomas

OBJECTIVE

To evaluate the safety, efficacy, and techniques of laparoscopic myomectomy as treatment for symptomatic uterine myomas.

DESIGN

Medline literature review and cross-reference of published data.

RESULTS

Results from randomized trials and clinical series have shown that laparoscopic myomectomy provides the advantages of shorter hospitalization, faster recovery, fewer adhesions, and less blood loss than abdominal myomectomy when performed by skilled surgeons. Improvements in surgical instruments and techniques allows for safe removal and multilayer myometrial repair of multiple large intramural myomas. Randomized trials support the use of absorbable adhesion barriers to reduce adhesions, but there is no apparent benefit of presurgical use of GnRH agonists. Pregnancy outcomes have been good, and the risk of uterine rupture is very low when the myometrium is repaired appropriately.

CONCLUSION(S)

Advances in surgical instruments and techniques are expanding the role of laparoscopic myomectomy in well-selected individuals. Meticulous repair of the myometrium is essential for women considering pregnancy after laparoscopic myomectomy to minimize the risk of uterine rupture. Laparoscopic myomectomy is an appropriate alternative to abdominal myomectomy, hysterectomy, and uterine artery embolization for some women.

A randomized trial of danazol pretreatment prior to endometrial resection

OBJECTIVES

To assess the effect of danazol pretreatment in women undergoing endometrial resection for dysfunctional uterine bleeding.

STUDY DESIGN

A total of 132 patients were randomly divided into danazol pretreated and untreated groups. Endometrial resection was carried out using a 24Fr cutting wire loop electrode and 1.5% glycine as the distension media. Patients were followed-up for 6 years. The t-test and Chi-square tests were used to test differences between the two groups.

RESULTS

The mean endometrial thickness, fluid used, fluid deficit, weight of resected tissue and duration of surgery were significantly greater in the unprepared group. Over 70% of patients in both the groups achieved amenorrhoea or spotting. Two (1.5%) patients underwent a repeat procedure and two (1.5%) others a hysterectomy, while the rest had hypomenorrhoea. The perimenstrual symptoms also showed significant improvement. No statistically significant difference was found in the outcomes of the two groups.

CONCLUSION

Endometrial resection is an effective alternative to hysterectomy and pretreatment of the endometrium is not necessary for good outcomes.

Endometrial laser intrauterine thermo-therapy (ELITT): a revolutionary new approach to the elimination of menorrhagia

Various non-hysteroscopic procedures have been developed in the attempt to treat dysfunctional uterine bleeding that fails to respond to medical treatment efficiently and easily. Among these procedures is low-dose laser radiation of the endometrium with the diode source, which is characterized by the highest incidence of amenorrhea.