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Waveforms for endometrial ablation compared: when using the rollerball, cutting and coagulation are equally effective, a first-ever study concludes.(GYNECOLOGY)(Clinical report)
LAS VEGAS -- Cutting and coagulation waveforms are equally effective for hysteroscopic endometrial ablation using the rollerball, results from the first clinical study of its kind demonstrated.
An in vitro study from the early 1990s showed that the depth of thermal injury to 3 mm of myometrium (the depth of destruction believed to completely destroy the basal layer) was found to be more consistent with use of the low-voltage cut waveform compared with the high-voltage modulated coag waveform (Obstet. Gynecol. 1993;82:912-8). However, no published clinical trial has compared the two radiofrequency waveforms after rollerball endometrial ablation. Dr. T. Chang said at the annual meeting of the AAGL.
The low-voltage cut waveform, which heats the tissue more slowly. "is more likely to result in deep and homogenous tissue penetration while the high-voltage modulated coag waveform is more likely to result in superficial tissue desiccation and subsequent increase in tissue inpedance," said Dr. Chang, a specialist in minimally invasive gynecology and infertility at the Toronto Centre for Advanced Reproductive Technology.
In a trial intended to serve as a pilot study for a larger randomized trail. Dr. Chang and his mentor, Dr. George A. Vilos of the University of Western Ontario, London, allocated 47 premenopausal woman to hysteroscopic electrocoagulation of the endometrium using a 5-mm diameter rollerball with cut or coag wave forms at 100 watts of power. Eligibility criteria included symptomatic menorrhagia, no desire for future pregnancy, no intramural or submucosal myomas 3 cm or larger, no active pelvic inflammatory disease, and no atypical endometrial hyperplasia or cancer. The average age of the patients was 41 years and the average body mass index was 28 kg/[m.sup.2].
Of the 55 women 22 were in the cut waveform group and 23 were in the coag waveform group. One ...
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