Thermoregulated radiofrequency endometrial ablation.

OBJECTIVE: To test the hypothesis that treating dysfunctional uterine bleeding by automated application of electrothermal energy to the uterine cavity, with precise regional control, might yield results equivalent to those reported for hysteroscopically directed laser and electrosurgical endometrial ablations. MATERIALS AND METHODS: Patients with life style compromising menorrhagia, referred to six gynecologic surgical centers for hysterectomy or endometrial ablation, were admitted to the study if they had normal cervical cytology, a benign endometrial biopsy, no defined cause for their bleeding, and consented to participate in the evaluation of a newly developed Vesta DUB Treatment System. The device consists of a silicone-inflatable electrode carrier to be inserted into the uterine cavity and a controller to monitor and distribute current from a matched electrosurgical generator. Treatment involved a 3-minute or shorter warm-up period and a 4-minute treatment phase. RESULTS: Three- to 24-month follow-up data were available for 187 patients, with a mean follow-up of 14.8 months. The amenorrhea rate was 38%. Bleeding was reduced in 95% of patients. Actuarially, 88 +/- 3% of patients should expect to be free of menorrhagia, dissatisfaction, or need for a second procedure out to 24 months. CONCLUSIONS: The unique regional feed-back control offered by this system causes thorough, evenly distributed, thermal destruction 4-5 mm into the myometrium that reduces bleeding with durability equivalent to published reports of hysteroscopic endometrial ablation.

Hysteroscopic treatment of early pregnancy conceived despite intrauterine contraception.

PIP: Experience with a hysteroscope for management of pregnancy with and IUD in place in 28 cases is described. Patients had positive pregnancy tests, were 6-11 weeks pregnant, aged 21-37, and 11 were primigravidae. An operating hysteroscope with a 7 mm shaft and wide-angle objective was used with a single handed control, and carbon dioxide insufflation. 2 women had no gestational sac, and were found on laparotomy to have ectopic pregnancies. 5 women had abnormal gestations visible macroscopically, by their green, brown, clotted, folded or atonic gestational sac. 21 patients had apparently normal pregnancies, of which 3 had no IUD in situ and 18 had an IUD. The procedures took 20 minutes maximum, and were not painful for gravid women. Vaginal bleeding lasted about 3 days. Pregnancy outcomes were 13 term infants, 2 spontaneous abortions, 1 premature, and 2 still pregnant. The advantages of hysteroscopy are certain diagnosis with location of the IUD, noninvasive, painless outpatient procedure, and no damage to the fetus.^ieng