Protocol eases switch to office-based ablation: guidelines from the ACS, ASA, and liability insurance providers are included in the protocol.(Gynecology)

CHICAGO -- Global endometrial ablation can be performed easily and safely in the office as long as physicians are adequately prepared and strictly adhere to protocols, Dr. Ted Anderson said at the annual meeting of the AAGL (formerly the American Association of Gynecologic Laparoscopists).

Dr. Anderson and his associates developed a protocol incorporating guidelines for office-based procedures from the American College of Surgeons, American Society of Anesthesiologists (ASA), personal or published accounts, and professional liability insurance providers.

Some of its primary considerations are:

* Strict adherence to the indications and contraindications for each technique.

* Thorough diagnostic evaluation. Imaging and sampling should be done in advance to avoid surprises and to determine the thickness of the myometrium, a frequently overlooked aspect.

"Doing these procedures in the office is not the place for an atypical patient or an atypical uterus," he said. "You want a straightforward procedure, don't take risks, and keep in mind that doing this procedure in your office is not just simply changing the place that you're doing it. It's a mentality that you're changing as well. You need to be absolutely comfortable before you move to the office."

* Careful patient selection. Consider American Society of Anesthesiologists class I or II patients only. Avoid patients with comorbid conditions such as asthma, anxiety, obesity, or heart disease which might decompensate in the office.