A.

KAVITHA
 Hystrectomy-100% success rate
 Disadvantages
the diseased organ is only
endometrium

 Long term complications – urinary

dysfunction, cvs problems
 So better choice is MIS
 An alternative to hysterectomy when medical
management fail
 The idea for this procedures evolved from
pathology that happens in Ashermann
syndrome leading to amenorrhea
 The basic principle is ablation of
endometrium
 MIS

I GENERATION
II GENERATION
III GENERATION

•Nd –YAG LASER •THERMAL BALOON

•ELECROSURGERY •NOVASURE
•MICROWAVE
•TCRE •CRYOPROBE
• ROLLER BALL •HYDROTHERMAL
•RADIOFREQUENCY
INDICATIONS CONTRAINDICAIONS

•Intractable uterine •Uterine size>12wks

bleeding •Any pathology in uterus
•Coagulopathies-risk •Pregnancy
for hysterectomy
•Acute pelvic
•Age >40yrs inflammation
(completed family)
•Scarred uterus
•Not willing for
hysterectomy
PREREQUISITE
 preoperative thinning of endometrium –

danazol 200 mg tds -6 wks,

Gnrh analogues 3 months
 Immediate Post menstrual period – endometrial thickness < 3 cm

PRE OPERATIVE PREPARATION:

 Evaluate completely and rule out CI

INTRA OPERATIVE:
 Anaesthesia – GA or regional
 Position – dorsal lithotomy
 •Under
HYSTEROSCOPE
•Distension medium-
1stGeneration irrigate

OBJECIVE of Ablation is to cause thermal

damage to the basalis layer of endmetrium
 Distension-saline
 5mm destroyed
 SUCCESS RATE-95%
 ADVANTAGE
 More precise
 Lesser complication
 TCRE
•‘U’ shaped loop
•3-5mm myometrium resected
•SUCCESS RATE
50%Amenorrhoea
96%Hypomenorrhea
• ADVANTAGE

Cheap,sampling,low failure
rate
TRANSCERVICAL ENDOMETRIAL
RESECTION
ENDOMETRIAL

ABLATION
ROLLER BALL
••2-4MM
2-4MM
ball/barrel/ovoid
ball/barrel/ovoid
••Uniform
Uniformvapourisation
vapourisation
••FAILURE
FAILURERATE RATE5-5-
10%
10%
••ADVANTAGE
ADVANTAGE
Low
Lowrate
rateof
of
perforation
perforation
Short
Shorttime
time
ROLLER BALL ENDOMETRIAL
ABLATION
 Perforation
 Haemorrhage
 Gas embolism
 Infection
 Damage to vessels,bowels,urinary bladder
 Fliud absorbtion-lead to
HT,Hyponatremia,neurological
symptoms,haemolysis and even death
Hence,fluid input/output should be monitored
 •No hysteroscope
•No distention media

2 Generation
nd •Risk of 1st generation tech
minimised
 Central computer system with disposable silicon
balloon catheter 5mm
 Insert
 Inflate balloon- 5%dextrose+water
circulate
 Heat-87deg for 8min and deflate
 ADVANTAGE
 Low complications
 No special skill
 Effective and safe 85% success rate
THERMOCHOICE
 Disposable 3D fan shaped fabric like
expandable with metallic skeleton is
used
 Outer sheath removed
 With high frequency electro
generator electrocoagulation is done
NOVASURE
 No HYSTROSCOPE
Even no distention
media
Only probe is used

3rdGeneration
 Magnetic energy-9.2GHz
 8mm applicator
 Temp 80 deg -3min
 6mm destroyed
 ADVANTAGE
No bleed,no fluid load
MICROWAVE ENDOMETRIAL
ABLATION
 CRYOABLATION
 RADIOFREQUENCY INDUCED THERMAL
ABLATION
 HYDROTHERMAL
 ELITT-Endmetrial LASER Intrauterine
Thermotherapy
HYDROABLATION
 Rapid recovery
 Normal diet
 May be bleeding slighty-
serosanguinus discharge-profuse
watery discharge
THANK
YOU