Hysteroscopic Endometrial Ablation Is an Effective Alternative to Hysterectomy in Women with Menorrhagia and Large Uteri

To examine the feasibility, safety, and outcome of hysteroscopic endometrial ablation, and to determine the volume of fluid absorbed during resection versus rollerball coagulation in women with menorrhagia and large uteri. Retrospective review (Canadian Task Force classification II-2). University-affiliated teaching hospital. Forty-two consecutive patients (mean ± SD age 45.6 ± 6 yrs) with uterine size greater than 12 weeks (cavity >12 cm). Endometrial ablation; 26 (62%) women were pretreated to thin the endometrium. Resection was performed in 27 patients (65%) and rollerball coagulation in 15 (35%). Ablation was successfully performed in all patients in a day surgery setting. Multiple regression analysis examined the relationship of uterine size, pretreatment, procedure, and duration of surgery to amount of glycine absorbed. Glycine absorption was higher with resection than with coagulation (p = 0.04). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.04) but not with duration of the procedure, uterine size, or pretreatment. One patient with uterine fibroids and one with endometrial adenocarcinoma had hysterectomy. With follow-up of 39 (95%) of 41 women (excluding the one with adenocarcinoma) for 14 ± 2 months, 38 (93%) were very satisfied. Thirty (73%) had amenorrhea, six (15%) had hypomenorrhea (