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Endometrial cryoablation, a minimally invasive procedure for abnormal uterine bleeding
T J Rutherford1, T G Zreik, R N Troiano
1Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Study Objective:
To evaluate the effectiveness of endometrial cyroablation for abnormal uterine bleeding.
Design:
Prospective study with 22 months follow-up (Canadian Task Force classification II-2).
Setting:
University Medical Center.
Patients:
Fifteen consecutive patients treated for metrorrhagia or menorrhagia refractory to medical or surgical therapy, and who were either not operative candidates or did not desire hysterectomy.
Intervention:
Cyroablation of the endometrium.
Measurements And Main Results:
Fifteen patients underwent 16 procedures for dysfunctional uterine bleeding. Uterine sounding depth was 6 to 15 cm. One patient had spinal anesthesia, seven had general anesthesia, and seven had intravenous conscious sedation with a cervical block. Eight patients underwent cryosurgery while fully anticoagulated. Posttreatment endometrial biopsies were performed on three patients and showed only granulation tissue. Life table calculations give amenorrhea rates of 75.5% at 6 months and 50.3% at 22 months. One woman underwent a repeat procedure, resulting in hypomenorrhea at 7-month follow-up.
Conclusion:
This pilot study suggests that endometrial cryoablation may be performed simply and effectively. Future studies should be designed to optimize the technical aspects of the procedure, determine its relative efficacy, and investigate the indications.