Retained Tubocornual Endometrium and the TUMA Procedure

We performed total uterine mucosal ablation (TUMA), a laparoscopic-assisted alternative to hysteroscopic endometrial ablation, in 10 women (mean age 41.2 yrs, mean parity 3.7) with therapy-resistant dysfunctional uterine bleeding. The endometrial cavity, adjacent myometrium, and fundus were ablated under general anesthesia. Hemostatic sutures were applied to the fundus and cervix. Mean operating time was 53 ± 7.3 minutes. In two women bilateral salpingo-oophorectomy was performed due to benign ovarian pathology. The rest of the patients had functional ovaries, and menstruation returned in five of them. Three of the five had hematometra due to blunt perforation of the cervix. One woman had a hysterosalpingogram to assess the uterine cavity and two had total abdominal hysterectomy due to pelvic pain. The endometrial cavities in these three women were normal, without synechiae. The results of TUMA were considered satisfactory by 70% of women.