Endometrial ablation (hysterectomoscopic, laser): what it is

Some women experience discomfort from a significant amount of blood released during menstruation, sometimes with clots when critical days continued for a long time and there is a disturbance of the cycle. This phenomenon is called hypermenorrhea.

Continuous blood loss leading to anemia and other serious consequences. Due to the lack of iron there is a shortage of red blood cells that transport oxygen, the lack of which causes lethargy, loss of interest in life, depression. In the absence of the effect of prescribed treatments physicians can offer a radical method - scraping.

There is also a gentle way, without involving surgery - endometrial ablation - is the elimination of the internal mucous layer of the uterus. This procedure is also called resection.

The method

Endometrial ablation (ablation) - removal of a functional layer to a thickness of 6 mm, together with possible tumors. Endometrium can remove completely or leave the particle at the beginning of the cervical canal. Such interference occurs without a scalpel.

Its consequences - the cessation of menses or the normalization of the menstrual cycle.

The destruction of the endometrium and muscle membrane sector with the existing formations produced without traditional instruments surgeon with modern minimally invasive techniques. The event was held in a small operating room with general anesthesia - general or spinal.

Removal of tissue in the uterus allows a woman to feel calmer himself in menstrual days, getting rid of the unpleasant and painful menstruation.

testimony

Offering to get rid of menorrhagia endometrial ablation, your doctor will explain what it is, tell you about the indications and contraindications.

The thickness of the tissue depends on the hormone level: it is incremented in preparation during ovulation implement fertilized egg. If conception has not occurred, mucous discharge and menstruation occurs. Large blood loss is due to a hormone imbalance, poor blood clotting, tumors, prevent or ectopic pregnancy, diseases of reproductive organs. Excision of the shell of the endometrium would solve some of these problems.

When ablation is recommended:

• uterine bleeding, with copious, beyond the classical therapy;
• giperplazivnyh changes in the uterusMainly in the period of menopause;
• refusal to have surgery to remove the uterus (if available in this premise).

Offering young women able to bear children, endometrial resection, account for its reluctance in the future to have a baby.

Contraindications

Endometrial ablation is not suitable as a method of treatment if a woman has an infectious-inflammatory abdominal disease, sexually transmitted expressed coagulation disorders, tumor.

Removal of tissue is not recommended in febrile conditions, the final stage of progression of chronic diseases, endometriosis.

Pregnancy more than two months is a contraindication for categorical procedure as recent surgery with the available fresh seam on uterine wall (Caesarean section).

During operation rejected mucosa, destruction fully exposed and discharged to the outside. Histology in the lion's share of cases can not be done, because the protein molecules "stick together."

To avoid complications, ablation is preceded by a thorough examination:

• Deposit of general analyzes of urine and blood;
• analysis of blood biochemistry;
• setting its coagulation;
• vaginal smear for purity;
• cardiac cardiogram;
• ultrasound examination of the genital organs;
• establishing hormone levels.

Before the appointment date of the operation the doctor must determine the shorter Endometrial thickness on days cycle(5-7-day cycle). At irregular critical days accounted for US data. If confirmed cancer of the uterus, or there is a risk of malignant transformation, from the ablation has to be abandoned.

How is the ablation

Ablation of endometrial cancer after examination requires brief hospitalization woman (usually about 2 days). Before manipulation of hormonal therapy it can designate a partial reduction of the endometrial tissue, which will completely remove the entire layer of the shell including an upper.

The patient is on the operating chair, lying on her back with her hips slightly raised.

Advance inside the vagina makes palpation (bimanual examination) to determine the location and size of the uterus. After treatment of external organs antiseptic uterine cervix reinforce forceps is introduced into the cervical canal dilator.

Verify the reliability of the equipment into the uterine cavity resectoscope is introduced for inspection of each body part.

discovered endometrial polyps on surface or small units will not be a reason to cancel the operation. Their excised loop electrode and the cut fabric is sent for histology.

With care and operate in case of the partition in the cavity of the uterus body or bicornuate.

After all these manipulations start to endometrial resection. To do this, use one of the following techniques:

• electrosurgical destruction;
• laser ablation;
• gidrotermoablyatsiyu;
• microwave ablation.

Electrosurgical destruction of the endometrium

Electrosurgical endometrial ablation is performed to dissect adhesions and adhesions of the uterus, its interior walls, getting rid of the polyps, fibroids, endometrial resection. There is some evidence, as a result of this operation, women retain the ability to conceive and give birth. It all depends on their age, diagnosis and status.

If the entire surface is subjected to changes in the endometrium and it needs to be completely removed, fertility is lost.

Elektroablyatsiya contraindicated in enlarged size genitals (corresponding to 9-10 weeks pregnancy), cancers of the endometrium and the uterus, its loss, tumors of the genital organs malignant origin. Such operation is considered to be gentle, as carried within the uterus through the cervical canal.

To reduce the risks and to achieve optimal results, before the operation the woman is prescribed hormones to reduce the genitals and reduction. Smooth movement using ball or roller electrodes evenly sear skin. In the final steps all damaged vessels coagulated (solder) special ball electrode.

Furthermore cauterization of tissue using the cutting method loop electrode when endometrium removed, if sostrugivaya, with the tip of the myometrium. Movements in the downward direction, before reaching the internal os gradually produce interference from uterine fundus towards the rear wall.

And apply the combined method in which the surface is treated with a basic loop, and the space around the fallopian tubes and large arteries degraded ball electrode.

Features of laser ablation

Laser ablation is carried out contact and contactless methods. In both cases, the processing starts with the fallopian tubes toward the cervical canal.

The laser beam is directed to the lining of the uterus and solder it. As a result, the contact exposure mucosa swells, changes color, turns into rags and gas bubbles, and thus the procedure requires washing the uterine cavity.

When using a fiber-laser risk of bleeding significantly reduced because the damaged vessels does not gape - they are firmly coagulated. On the laser ablation takes very little time - about 30 minutes.

Gidrotermoablyatsiya

This procedure involves the destruction of tissue by thermal burns. Silicone catheter with a balloon mounted thereon with integrated heating element comprising a heated glycerin is introduced into the uterine cavity and left there for a certain time (about one hour). The balloon is inflated and heated, then blown off and removed from the body.

Disadvantages of this method are the inability to determine the depth of tissue destruction, endometrial probable saving in inaccessible places (around the mouth of the fallopian tubes).

Contraindications to gidrotermoablyatsii - deformed or enlarged uterus, the presence therein of scars and adhesions, intrauterine septum. After surgery, frequent uterine discharge, indicating inflammation, infection organ bleeding.

Microwave endometrial ablation

This process of exposure to microwaves, which raise the temperature to 70-80 degrees, and dehydrated instantly destroyed mucosa.

The destruction of the endometrium takes place for 5 minutes. Microwaves are a depth of about 6 mm, therefore it is necessary to take into account the thickness of the middle layer of uterine muscle. It should be at least 10 mm. Otherwise there is a possibility of perforation. Such ablation is considered the most effective means of removing the endometrium, which allows for the normalization of the menstrual cycle.

Risks and possible complications

Like any surgery, endometrial ablation is coupled with pain, so its implementation require anesthesia. After the final procedures woman may experience mild cramping abdominal pain, impaired urination, painful sensation in the back and waist, morning sickness, which usually take place per day. Such manifestations of complications can not be considered because they are characteristic of the amendments from the anesthesia, the forced dilation of the cervix and ablation.

Far more dangerous if manipulation electrode or catheter will damage the uterine wall. Then it requires rapid stitching holes and inspection of the abdominal cavity.

After surgery, there are complications:

• odor from the vagina;

• pus mixed with blood as a result of infection of the uterus;
• severe bleeding, likely during the deformation of large vessels, especially dangerous if there are blood clots;
• water intoxication, in which there is the risk of cerebral edema and pulmonary, cardiovascular and acute renal failure;
• failure in the functioning of adjacent organs, are exposed to heat;
• and cervical mucosal burns (non-compliance with the operation of machinery).

Remote consequences of the uterus resected after a certain time after the soldering operation can be between its walls, closing the cervix, bleeding from the uterus (endometrium if not removed completely).

Ablation of pregnancy

When planned pregnancy from endometrial ablation should be discarded. The possibility of conception as a result of its implementation in most cases remains low. Therefore, the doctor must inform the woman that the probability to have a baby after the procedure is minimized. The operation usually offer the fairer sex in menopause.

The result of ablation of a woman in an interesting position becomes a miscarriage. And if the pregnancy after the operation is still going on, the lack of tissue in the uterus is an obstacle to the full power of the future baby.

Recovery from ablation

To fully recover after ablation will need from 2 to 6 months. The first week of a woman may feel discomfort. It happens spotting that are a few weeks later.

After 2-3 months of normal menstrual cycles. For women in menopause month absence.

Doctors' recommendations:

1. Avoid emotional turmoil and stress.
2. Rational to eat (food must be balanced).
3. Postpone sex until permission of the doctor.
4. Do not give up visits to the gynecologist.