Rollerball endometrial ablation: a histological study in danazol pretreated patients

Endomyometrial biopsies were taken from danazol pretreated patients about to undergo rollerball endometrial ablation for menorrhagia. The biopsies were taken with a loop electrode at hysteroscopy before and after 1, 2, 3 passes of a rollerball electrode over the endometrium using powers of electrocoagulation diathermy varying from 30 to 100 watts. The biopsies were then assessed histologically. Nineteen biopsies from the perceived endocervical canal, 25 posttreatment curettings and 3 hysterectomy specimens were also assessed. Biopsies taken after danazol pretreatment but before diathermy showed a thinned inactive endometrium. A histological classification of the effect of electrocoagulation diathermy on the endometrium was developed describing increasing endometrial damage. The degree of endometrial damage was directly related to the number of rolls of the ball over the endometrium and to the power of electrocoagulation diathermy. Endometrium was found in 84% of biopsies from the perceived endocervical canal and endometrium was found in curettings from 3 of 11 patients who were amenorrhoeic following ablation.