Radiofrequency Endometrial Ablation with Hysteroscopic Verification: Report of Four Cases Conducted in Brazil / Ablação Endometrial por Radiofrequência e Verificaçao Histeroscópica: Relato de 4 Casos Conduzidos no Brasil

Endometrial ablation (EA) is a minimally invasive surgical procedure to reduce abnormal uterine bleeding contemplated for women who have achieved their reproductive goals. EA consists of the destruction of the endometrial layer with preservation of the uterus, although EA has lower complication rates than hysterectomy, it may be associated with metrorrhagia recurrence. One of the major causes of treatment failure is incomplete ablation of the endometrium. Thanks to techniques that have been developed in recent years, endometrial ablation can be performed on an outpatient basis, including by radiofrequency ablation. The main objective of this case series was to report four cases in which Radiofrequency Endometrial Ablation (RFEA) was used to treat abnormal uterine bleeding at a single ambulatory surgical center in Brazil. Hysteroscopic evaluation of the uterine cavity was performed immediately prior to the RFEA to diagnose possible endometrial pathologies and again at the conclusion of the procedure to assess the aspect of the newly treated endometrium. Verification of the completeness of the ablation was assessed by a third hysteroscopy 30 or 60 days after the ablation. In this case series RFEA was efficacious and safe for outpatient use. Although radiofrequency endometrial ablation can be performed without the use of the hysteroscope, we believe it is an important tool for the timely verification of the completeness of the endometrial ablation. (AU)

A ablação endometrial (AE) é um procedimento cirúrgico minimamente invasivo destinado a mulheres com prole estabelecida visando redução do sangramento uterino anormal. A AE consiste na destruição da camada endometrial com a preservação do útero, apesar da AE possuir menores índices de complicação do que a histerectomia, pode estar associada a recorrência do sangramento. Uma das causas da falha de tratamento é a ablação incompleta do endométrio. Atualmente, a ablação endometrial pode ser realizada ambulatorialmente graças às técnicas que vêm sendo desenvolvidas nos últimos anos, as quais incluem o uso de radiofrequência. O objetivo dessa série de casos é descrever 4 casos de Ablação Endometrial por Radiofrequência (AERF) para o tratamento de sangramento uterino anormal realizados em um mesmo ambulatório especializado no Brasil. Uma avaliação histeroscópica da cavidade uterina foi realizada imediatamente antes da AERF para diagnosticar possíveis patologias endometriais e imediatamente ao final do procedimento, para avaliar o aspecto do endométrio recém tratado e a necessidade de nova aplicação de radiofrequência. A integralidade da ablação foi verificada por uma terceira histeroscopia após 30 ou 60 dias depois da ablaçao. A técnica mostrou-se adequada para uso ambulatorial. Embora a ablação endometrial por radiofrequência possa ser realizada sem o uso do histeroscópio, acreditamos que seja uma ferramenta importante para a verificação oportuna da integralidade da ablação endometrial. (AU)

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases.

PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II(-1)). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min(-1)). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age ≤ 50 years, body surface area (m(2)), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442 ± 616 versus 223 ± 332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R(2)=0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R(2)=0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy.

Predictors of fluid intravasation during operative hysteroscopy: a preplanned prospective observational study with 200 cases / Preditores de intravasamento durante histeroscopia cirúrgica: um estudo observacional prospectivo com 200 casos

PURPOSE: To verify the predictors of intravasation rate during hysteroscopy. METHODS: Prospective observational study (Canadian Task Force classification II-1). All cases (n=200 women; 22 to 86 years old) were treated in an operating room setting. Considering respective bag overfill to calculate water balance, we tested two multiple linear regression models: one for total intravasation (mL) and the other for absorption rate (mL.min-1). The predictors tested (independent variables) were energy (mono/bipolar), tube patency (with/without tubal ligation), hysterometry (cm), age≤50 years, body surface area (m2), surgical complexity (with/without myomectomy) and duration (min). RESULTS: Mean intravasation was significantly higher when myomectomy was performed (442±616 versus 223±332 mL; p<0.01). In the proposed multiple linear regression models for total intravasation (adjusted R2=0.44; p<0.01), the only significant predictors were myomectomy and duration (p<0.01).In the proposed model for intravasation rate (R2=0.39; p<0.01), only myomectomy and hysterometry were significant predictors (p=0.02 and p<0.01, respectively). CONCLUSIONS: Not only myomectomy but also hysterometry were significant predictors of intravasation rate during operative hysteroscopy. .

OBJETIVO: Testar preditores do ritmo de intravasamento durante histeroscopia cirúrgica. MÉTODOS: Estudo prospectivo observacional (classificação: Canadian Task Force II-1) incluindo casos conduzidos em centro cirúrgico (n=200 mulheres; 22 a 86 anos de idade). Considerando os erros de aferição nas embalagens de solução de irrigação para calcular o balanço hídrico, nós testamos dois modelos de regressão linear múltipla: um para intravasamento total (mL) e outro para ritmo de intravasamento (mL.min-1). Os preditores testados (variáveis independentes) foram energia (mono/bipolar), permeabilidade tubária (com/sem ligadura tubária), histerometria (cm), status ovariano (idade≤50 anos), área de superfície corporal (m2), complexidade de cirurgia (com/sem miomectomia) e tempo de ressecção (min). RESULTADOS: O intravasamento médio foi significativamente maior quando miomectomia foi realizada (442±616 versus 223±332 mL, p<0,01). No modelo proposto para intravasamento total (R2 ajustado=0,44; p<0,01), os únicos preditores significativos foram miomectomia e tempo de duração (p<0,01). No modelo proposto para a taxa de intravasamento (R2=0,39; p<0,01), somente miomectomia e histerometria foram preditores significativos (p=0,02 e p<0,01, respectivamente). CONCLUSÕES: Não só a miomectomia mas também a histerometria são preditores significativo da taxa de intravasamento durante histeroscopia cirúrgica. .