A Minimally Invasive Gynaecological Intervention as an Outpatient Procedure
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- Category: Vol. 78, December 2010
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A Minimally Invasive Gynaecological Intervention as an Outpatient Procedure,AHMED M.M.K. NOOH
Abstract
Objective: To determine the feasibility in terms of prac-ticality, safety, patients’ satisfaction and effectiveness of the outpatient setting, without a general anaesthetic or a conscious sedation, in carrying out endometrial thermal balloon ablation.
Design: A prospective observational study.
Setting: The Royal United Hospital, Bath, England, UK.
Subjects and Methods: Fifty three women successfully underwent endometrial ablation using thermachoice balloon system for the treatment of menorrhagia as an outpatient procedure without a general anaesthetic or a conscious sedation over a 12 months period between April 2007 and March 2008. A questionnaire was sent 6 months post-operatively enquiring about the menstrual history after treatment, procedure-related complications and the need for further therapy-if any. Women were asked to select one of four choices (very satisfied, satisfied, dissatisfied, or very dissatisfied) to assess satisfaction with treatment. Improvement was recorded when participating women graded the heaviness of their menstrual blood loss as none (amenorrhoea) or lighter than before (hypomenorrhoea), while procedure failure was defined as persistent menorrhagia.
Results: The outpatient setting was successfully utilized in carrying out endometrial thermal balloon ablation under a local anaesthetic in 53 cases. Completed outcome question-naires were returned by 47 out of the 53 successfully treated women (88.7%). There was no equipment failure in this study. The procedure was well tolerated by most cases. However, 8 cases out of 47 (17%) expressed severe, but tolerable, pain or discomfort. In this study, no major intra-operative or post-operative complications were reported with the exception of two patients who developed severe abdominal cramps for which they were kept in hospital overnight and treated with narcotic analgesics, making an overall minor morbidity rate of 4.3%. However, in view of persistent menorrhagia, 7 pati-ents out of 47 (14.9%) required further treatment. The success rate of 85.1% was maintained over the follow-up period.
Conclusion: For treatment of menorrhagia, endometrial thermal balloon ablation, as an outpatient procedure, is feasible, safe, quick and simple. However, larger studies and longer follow-up are required to substantiate this impression.