Endometrial ablation/resection
Since 1981, patients have been able to choose endometrial ablation as a treatment for heavy periods and over the last 20 years, several endometrial ablation techniques have been introduced.
In 1981, Milton Goldrath wrote what is in effect the first description of endometrial ablation, using laser energy to destroy the endometrium in 22 women with menorrhagia (24). Sometime in the mid 1980s, Jacques Hamou, a well-known hysteroscopist from Paris, introduced what has become known as partial endometrial resection into Europe. Hamou popularized endometrial resection as well as hysteroscopic myomectomy in Europe and in 1988 at a meeting held in Oxford he taught the technique to a group of British clinicians. Discussions led to the introduction of the term ‘transcervical resection of the endometrium' (TCRE) (25).Patient selection
Careful patient selection is important. Criteria for offering this type of surgery are summarized in Table 48.1.
Table 48.1 Inclusion and exclusion criteria for hysteroscopic endometrial ablation
| Inclusion criteria | I Exclusion criteria |
| Abnormal uterine bleeding | Coexisting gynaecological pathology (e.g. uterovaginal prolapse, ovarian pathology, pelvic inflammatory disease, cervical atypia) |
| No desire for amenorrhoea | Endometrial atypia and cancer |
| Unsuccessful medical treatment | Submucous fibroids >2 cm |
| Endometrial biopsy negative for atypia and cancer | Uterus >12 weeks in size |
| Family complete | Anovulation, endometrial hyperplasia |
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More on the topic Endometrial ablation/resection:
- Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p., 2020
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