58353 Endometrial ablation, thermal, without hysteroscopic guidance

Name of the Procedure:

Endometrial Ablation, Thermal, without Hysteroscopic Guidance

Summary

Endometrial ablation is a medical procedure that uses heat (thermal energy) to destroy the lining of the uterus (endometrium) to reduce or stop heavy menstrual bleeding. This specific type does not use a hysteroscope (a thin, lighted tube) for visual guidance.

Purpose

Endometrial ablation addresses heavy menstrual bleeding that has not responded well to medication. The goal is to significantly reduce menstrual flow, and in some cases, it may stop menstrual bleeding entirely.

Indications

• Persistent heavy menstrual bleeding (menorrhagia)
• Iron-deficiency anemia due to heavy periods
• Women who do not wish to have more children (as the procedure can impair fertility)
• Failure of conservative treatments like medications or hormonal therapies

Preparation

• Patients may be instructed to fast before the procedure if sedation is planned.
• Medications may be prescribed to thin the endometrial lining.
• Diagnostic tests might include ultrasound to evaluate uterine size and shape.

Procedure Description

1. Patient lies on the examination table.
2. The doctor dilates the cervix to access the uterus.
3. A device that emits thermal energy (e.g., heated fluid, radiofrequency) is inserted into the uterus.
4. Thermal energy is applied to the endometrial lining for several minutes to destroy it.
5. The device is removed, and patient recovery is monitored.

Tools used may include radiofrequency devices, heated fluid-filled balloons, or electrically heated instruments. Local anesthesia or light sedation is typically provided for comfort.

Duration

The procedure usually takes about 15 to 30 minutes.

Setting

Typically performed in an outpatient clinic or surgical center.

Personnel

• Gynecologist or specialized physician
• Nurse to assist with the procedure and patient care
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Injury to the uterus or surrounding organs
• Thermal injury to nearby tissues
• Complications from anesthesia

Benefits

• Significant reduction in menstrual bleeding
• Improved quality of life
• Rapid recovery, usually within a few days

Recovery

• Post-procedure monitoring for a few hours
• Mild cramping and vaginal discharge are common
• Pain management with over-the-counter medications
• Avoiding heavy lifting and sexual intercourse for about 1 week
• Follow-up appointment to ensure proper healing

Alternatives

• Medication (e.g., hormonal treatments or nonsteroidal anti-inflammatory drugs)
• Intrauterine device (IUD) that releases hormones
• Hysteroscopic endometrial ablation
• Hysterectomy (removal of the uterus)

Pros and cons vary with each alternative, such as longer recovery time for a hysterectomy versus the minimally invasive nature of ablation.

Patient Experience

• During the procedure, patients may feel some cramping or discomfort.
• Post-procedure, mild pain or cramping can be managed with pain relievers.
• Most patients return to normal activities within a few days, although heavy bleeding and discharge may occur initially.