Endometrial ablation with the combined Nd:YAG laser-rollerball

Endometrial ablation, an effective treatment for intractable uterine bleeding, can be performed with hysteroscopic rollerball coagulation, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and endomyometrial resection techniques. Between November 1990 and January 1995, 49 women underwent ablation with the Nd:YAG laser and a nontouch technique on the ostia, uterine fundus, and upper one-third to one-half of the posterior uterine wall, in combination with rollerball coagulation over the entire endometrial surface after 60-W Nd:YAG application. The power source of the rollerball was set at 80 W of pure coagulation current. Each patient was pretreated with a gonadotropin-releasing hormone agonist or an antiestrogenic compound. The complications were one uterine perforation with a dilator with no sequelae, and one severe infection requiring hysterectomy. There were no failures. Of the 48 women available to follow-up, amenorrhea was achieved in 43 (90%). Two continued to spot very slightly on occasion, but did not require minipads. Three women had light flow requiring one to two tampons for 1 to 4 days every month. The technique continues to provide a very high rate of complete amenorrhea.