Modified endometrial ablation: electrocoagulation with vasopressin and suction curettage preparation

Patient preparation and a modified operative technique are described for electrocoagulation ablation of the endometrium using a roller-bar electrode. No preoperative or postoperative endometrial suppression was used. Rather, the endometrial cavity was denuded by suction curettage just before ablation, which was performed in the early proliferative phase of the menstrual cycle. Lidocaine paracervical block containing vasopressin was injected at the start of the procedure to control pain and to minimize bleeding and irrigation fluid absorption. Pulsed irrigation of the uterus was used to improve visibility through uterine debris and the bubbles generated by the electrical current. The first 20 patients who had electrocoagulation ablation of the endometrium with these modifications were compared with the first 18 patients who had laser coagulation ablation using standard technique and preoperative endometrial suppression. Compared with the laser method, the modified coagulation method resulted in a comparable rate of satisfactory bleeding decrease at 6 months (90 versus 94%), but involved a clinically significant reduction in total anesthesia time (66.8 versus 117.3 minutes) and volume of irrigation fluid used (5.7 versus 15.9 L).