In-office endometrial resection ablation can be safe, effective. (Study of 81 Surgeries).

SAN FRANCISCO -- Endometrial resection ablation for abnormal uterine bleeding doesn't necessarily require a hospital.

An analysis of 81 consecutive surgeries found that those performed on carefully selected patients in an office-based surgical suite were as safe and effective as the endometrial resection ablations done in a hospital, Mel Cohen reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

Many gynecologists, however, do not have the equipment needed to handle potential complications from the procedure in their offices. Limited insurance reimbursement also discourages physicians from investing in the equipment that would allow them to do more procedures in the office-although that may be starting to change.

In the study, Dr. Michael L. Moore performed the 34 office-based endometrial resection ablations; he or a gynecologic fellow or both did the 47 hospital-based procedures.

Patients were offered the surgery if they no longer desired reproduction and had no indication for operative laparoscopy Office-based endometrial resection ablation was restricted to patients who qualified as American Society of Anesthesiologists class I (healthy with no systemic disease). The presence of fibroids 3 cm or greater disqualified patients from office-based surgery, said Mr. Cohen, who is the CEO of Dr. Moore's practice in Denver.

Postoperative follow-up at 5 days, 6 weeks, 6 months, and 1 year found no differences between groups in amenorrhea rates. Approximately 87% in each group remained amenorrheic at 6 months.

No differences between groups were seen in demographics, type of anesthesia used, the proportion of surgeries done on an outpatient basis, the type of medium utilized, surgical time, or complication rates. In some cases, additional procedures were performed such as hysteroscopic myomectomy or hysteroscopic polypectomy, but the proportion of patients undergoing additional procedures did not differ between groups.