Video Office Rollerbar Endometrial Ablation Under Local Anesthesia Using 24 French Wolf Resectoscope and Aquasens™ Fluid Monitoring System

Abstract

The objective was to evaluate the safety and efficacy of video rollerbar endometrial ablation with patients under local anesthesia in the office operating room in the Women's Wellness Center, using only intravenous (IV) sedation and a paracervical block. Eleven patients underwent video office rollerbar endometrial ablation under local anesthesia and IV sedation per our protocol. Two other patients underwent rollerbar ablation under general anesthesia with a 27 French resectoscope in a local hospital. Diary scores for menorrhagia, premenstrual syndrome (PMS), dysmenorrhea, and their impact on life were obtained before and after the procedure. Six-, 12-, 24-, and 36-month followup of these patients is presented. Six- and 12-month followup of all 11 patients who underwent video rollerbar endometrial ablation in the office under local anesthesia and of the two hospital patients showed improvement in the number of bleeding days by 65%. Dysmenorrhea and PMS were improved by 66.67% and 78%, respectively. Seventy-five percent of all patients showed improvement in menorrhagia at the end of 1 year. Over 90% of the patients were very satisfied or satisfied with the outcome of the rollerbar endometrial ablation procedure in the office under local anesthesia or with the hospital-based procedures. All rollerbar patients would recommend the procedure in the office setting to other individuals. The total mean procedure time was 17 minutes. No complications occurred either intraoperatively or postoperatively. The 1- and 3-year analysis of both the video office rollerbar endometrial ablation under local anesthesia and hospital ablation cases yielded an amenorrhea rate of 38%. Two of our video office rollerbar endometrial ablation under local anesthesia patients had hysterectomies, which makes the true amenorrhea rate more like 30%. Initial surgical management for abnormal uterine bleeding with video office rollerbar endometrial ablation under local anesthesia as an alternative to hysterectomy is not only efficacious and cost-effective but safe, without compromising quality of care. Though our numbers are small for the video office rollerbar endometrial ablation under local anesthesia cases, the data seem to suggest that office-based rollerbar procedures work as well as hospital outpatient rollerbar procedures or potentially new more expensive nonhysteroscopic global ablations.