New techniques of endometrium destruction – alternative methods for histerectomy

There are many methods available, all of which aim at achieving long-term endometrial destruction. The effectiveness of any method is related to its ability to destroy the basal endometrium and hence prevent endometrial regeneration. The use of established methods of laser ablation and endometrial resection and roller ball ablation are limited by available expertise, which is necessary to obtain satisfactory results with low complication rates. The newer methods would appear easier to learn, but the long-term success of some is yet to be established. Hysteroscopic surgery entails a learning curve and to minimize complications, adequate supervision and training is necessary. The high level and cost of equipment and expertise has led to the development of more simple endometrial destructive methods. Those now in use include ballon ablation, hydrothermal ablation, cryoablation, microwave ablation, radiofrequency, Versapoint (bipolar) and photodynamic therapy.
Each method has advantages and disadvantages, but success, rates complication rates are delated to surgical expertise and patient selection. The advantages of these techniques include a shorter hospital stay and faster recovery than for hysteroscopy. There is also better patient satisfaction than with medical management. In addition, these procedures are most cost-effective than hysteroscopy, even when need for repeat ablation or subsequent hysterectomy for some patients is taken into account. Overall, complication rates associated with endometrial destructive techniques are about six per cent. The complications include failure to resolve menorrhagia, fluid overload, perforation and haemorrhagie requiring emergency hysteroscopy.