Endometrial Ablation with a Vaporizing Electrode in Women with Regular Uterine Cavity or Submucous Leiomyomas

To verify the technical feasibility and safety of endometrial ablation with a vaporizing electrode (Vaportrode), we performed operative hysteroscopy in a consecutive series of 40 women (mean ± SD age 45.3 ± 4.7 yrs) with established menorrhagia and uterine volume less than 12 weeks' gestation. The results in 26 women with a regular uterine cavity were compared with those in 14 patients who had submucous myomas with less than 50% intramural extension. Surgery was undertaken after 2-month treatment with a depot gonadotropin-releasing hormone agonist. Pure cutting current was set at 200 W. Mean ± SD operating time was 8.6 ± 2.4 minutes in women with a regular cavity and 14.4 ± 5.2 in those with submucous myomas (mean difference 5.8 minutes, 95% CI 3.4-8.3). Corresponding values for distention fluid absorption were, respectively, 76 ± 103 and 227 ± 138 ml (mean difference 151 ml, 95% CI 73-229). A significant correlation was observed between operating time and distention fluid deficit (Spearman r = 0.47, p = 0.002). No complications occurred and all the procedures were performed as day surgery. After a mean follow-up of 4 months, no recurrence of menorrhagia was reported. Endometrial ablation with the Vaportrode is rapid, effective, and safe. Fluid deficit, although significantly greater in women with submucous myomas than in those with regular cavities, always remained within safety limits and below the usual values observed after resection with the wire loop.