Endometrial Ablation: "Combination Procedure" (Nd:YAG Laser + Roller Ball Together)

Endometrial ablation is an effective treatment for intractable uterine bleeding. This can be accomplished using hysteroscopic electrosurgical rollerball, Nd:YAG laser, and with endomyometrial resection techniques. All ablations in this study were accomplished using the Nd:YAG laser and a "non-touch" technique on the ostiae, uterine fundus, and the upper 1/3 to 1/2 of the posterior uterine wall in combination with rollerball coagulation over the entire uterus after the 60 watt Nd:YAG application. The power source of the rollerball was set at 80 watts of pure coagulation current in most cases. Each patient was pre-treated with a GnRH agonist or an antiestrogenic compound. A total of 40 patients were treated beginning in November of 1990 until January 1994. Complete amenorrhea was achieved in 36 patients (90%). Two patients have slight monthly spotting requiring 1 to 2 mini-pads per month and two patients have light flow requiring 1 to 2 tampons for 1 to 3 days of the month. There were no failures. The complications were one uterine perforation with a dilator with no sequelae and one severe infection requiring hysterectomy. These promising results warrant further study of this "combination procedure."