Endometrial ablation or resection: Resectoscopic techniques
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
Endometrial ablation is a minimally invasive option for the treatment of abnormal uterine bleeding. Resectoscopic techniques are performed under hysteroscopic visualization, using resectoscopic instruments to ablate or resect the endometrium. These techniques are also referred to as standard or first generation ablation. Non-resectoscopic endometrial ablation is performed with a device that is inserted into the uterine cavity and delivers energy to uniformly destroy the uterine lining.
In current practice, non-resectoscopic endometrial ablation is performed in most cases. However, in our practice, we perform resectoscopic ablation if the shape or size of the uterine cavity will not accommodate a non-resectoscopic device or if the patient has had multiple cesarean deliveries, to avoid ablating over the hysterotomy scar.
Resectoscopic techniques for endometrial ablation will be reviewed here. General principles (eg, indications, contraindications, preoperative and postoperative care) of endometrial ablation, techniques for non-resectoscopic endometrial ablation, as well as other management options for abnormal uterine bleeding, are discussed separately. (See "An overview of endometrial ablation" and "Endometrial ablation: Non-resectoscopic techniques" and "Management of abnormal uterine bleeding".)
TYPES OF RESECTOSCOPIC ABLATION
Resectoscopic ablation is done under hysteroscopic visualization and requires the use of a resectoscope (picture 1). There are currently four techniques : (1) endometrial dessication with an electrosurgical rollerball or rollerbarrel (picture 2) ; (2) resection with a monopolar or bipolar loop electrode (picture 2) ; (3) radiofrequency vaporization; or (4) laser vaporization .
All methods dessicate the endometrium to the level of the basalis. The rollerball and rollerbarrel use thermal energy for heating the tissue to a temperature between 60 to 90ºC, which dessicates and destroys the tissue. No tissue is removed. Thermal energy is also used with the monopolar and bipolar loop electrodes. However, the loop electrodes also resect the endometrium beyond the basalis layer to the myometrium. The resected tissue is sent to pathology for histologic diagnosis.
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