Tactile Electrosurgical Ablation: A New Technique for Endometrial Ablation-A Preliminary Study
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- Category: Vol. 78, June 2010
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Tactile Electrosurgical Ablation: A New Technique for Endometrial Ablation-A Preliminary Study,ALI M. EL-SAMAN, HAZEM S.E. MOHAMMAD, MAHMOUD S. ZAKHERA, KAMAL M. ZAHRAN, EIMAN M. AHMAD and AHMAD O. SALEM
Abstract
Objectives: To experimentally study the feasibility of performing endometrial electrocoagulation without hysteros-copy or distension media.
Design: We constructed an insulated probe that was named tactile electrosurgical ablation probe (TEA probe) with a ball shaped end that works like the roller ball when it comes in direct contact with the thinned endometrium guided by tactile sense.
Setting: Department of Obstetric & Gynecology and Department of Pathology Faculty of Medicine, and Department of Histology Faculty of Veterinary Medicine, Assiut University, Assiut.
Subjects: The present work included in vitro studying of 13 hysterectomy specimens by the TEA probe and ex vivo study of 1 cases with dysfunctional uterine bleeding scheduled for hysterectomy.
Interventions: During the in vitro part of the study, fresh hysterectomy specimens were placed on the return electrode of diathermy and coagulated transcervically by the TEA probe for 5-10 minuets treatment time. The ex vivo phase of the study was done with the patient in dorsal lithotomy position. The abdomen was opened till exposure of the uterus, simul-taneously a vaginal speculum is inserted, and the cervix is exposed, painted and grasped with a tenaculum then the insulated curette (IC) is introduced through the cervix. Dila-tation is done if needed (up to Heger #7), then IC is connected to the diathermy active electrode socket and a 30 or 60 watt setting was used. The endometrial cavity was systemically coagulated. Then hysterectomy was performed and the uterus was opened, inspected for the depth of coagulation followed by comprehensive histopathologic examination.
Main outcome measure: The depth of thermal damage of the endo-myometrium, the presence of missed (non-coagulated) endometrium and the temperature of the serosal surface and utero-vesical pouch. Results: When the power of coagulation were 30 W and 60 W respectively and operating time not prolonged more than 10 minutes, the thermal damage covered endometrium and 2-5 mm of myometrium in depth. At such wattage and operating time the deepest destruction was only 19.12% of uterine wall. Serosal temperature was not exceeding 41.9Cº at any time during the procedure. No full thickness injuries were demonstrated either histologically or suggested by the temperature studies. Missed foci of untreated endometrium were found but roughly not exceeding 5% of the endometrial surface area.
Conclusion: The results of this preliminary study confirms that tactile electrosurgical ablation probe (TEA probe) ablation produces a reproducible thermal injury without evidence of serosal heating or full thickness damage. Results suggest that the treatment time could be reduced to less than 10-min without detrimental effect on the depth of thermal damage. This hypothesis is currently being evaluated by clinical efficacy studies.