Thermal Balloon Ablation
In 1994 Neuwirth et al. introduced a thermal uterine balloon therapy system. The results achieved with it are comparable with the hysteroscopic endometrial resection, except that the skills the operator must possess are significantly smaller. The uterine thermal balloon ablation does not require endometrial visualisation, distending solutions, high energy sources, and almost never a cervical dilatation. The rate of postoperative complications for balloon ablation is about 3%, while the operative time is significantly shorter. The procedure can be done under local anesthesia in an outpatient clinic, which means the operative room can be used less.
Why Thermal Ballon Ablation!?
Thermal Balloon Ablation was invented to rectify the shortcomings of the first generation of endometrial ablation procedures. Hysteroscopic endometrial resection and ablation proved themselves successful in up to 70-90% of cases of heavy menorrhagia, but the former has at least two disadvantages:
-- the surgeon must have an excellent training in the method, and
-- serious complications may occur. Amongst them are: fluid overload, uterine perforation, infection, haemorrhage, thermal injuries, and even death.
Empirical data show that various ablation techniques, for instance, roller-ball and Nd Yag laser, had the rate of postoperative complication less than 4.4%, which is lower then for the hysteroscopic endometrial resection.
THERMACHOICE Thermal Balloon Ablation Device
In 2003, a new version of the already known thermal balloon ablation device called THERMACHOICE III, appeared. The candidates for this treatment are as follows:
-- pre-menopausal women with regular uterine cavity and no cervical or endometrial malignancies,
-- a completed family (no desire to have any more children),
-- although rare, the patient can be allergic to latex, so it is a contraindication as well.
The procedure is to insert a balloon catheter into the uterus and inflate it with a small amount of sterile fluid. In THERMACHOICE, the catheter is 16 cm long and 3 mm wide, and at its end is a latex balloon filled with 5% dextrose heated to 87°C for 8 minutes. The pressure inside the balloon is maintained between 150-180 mmHg. After these 8 minutes, the fluid is pulled back from the device, the catheter also goes out and nothing stays in the uterus. The whole procedure takes no more than 30 minutes to complete. The uterus will take about 7 to 10 days to heal, while the woman can get back to her normal life the very next day.
The Factors Pro et Contra Thermal Balloon Ablation with THERMACHOICE
The following factors ensure the more successful outcome:
-- the increasing age of the patient,
-- higher balloon pressure,
-- smaller uterine cavity and
-- a lesser degree of pre-procedure menorrhagia.
To the contrary, the factors to increase the risk of treatment failure are:
-- the patients of young age,
-- a prolongued duration of menstruation,
-- a retro-verted uterus and
-- endometrial thickness of at least 4 mm.
Thermal Balloon Ablation -- the Conclusion
With ablation, seven out of ten women avoid further gynecological intervention such as another endometrial ablation, dilatation and curetage (D & C), or the hysterectomy itself. There was no endometrial carcinoma reported amongst the balloon ablation patients. The complete amenorrhea for thermal ablation is 25-35%, and the failure rate is 10-30%. The rest of the patients have light spotting, or light or normal menstrual flow.
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