Laser endometrial ablation with the neodynium: yttrium-aluminium garnet (Nd-YAG) laser: a review of ninety consecutive patients.

OBJECTIVE

To assess the effectiveness of laser endometrial ablation in women with dysfunctional bleeding.

DESIGN

A retrospective analysis of 90 patients.

SETTING

Department of Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, U:K.

SUBJECTS

Ninety patients with dysfunctional uterine bleeding who were hysteroscopically suitable for laser endometrial ablation.

INTERVENTIONS

Endometrial laser ablations using the neodynium-yttrium-garnet laser at 70 watts power output.

MAIN OUTCOME MEASURES

Patient satisfaction/dissatisfaction at 6 months follow-up and response to repeat ablation.

RESULTS

A total of 117 procedures were carried out on the 90 patients. There was one suspected perforation which was not confirmed at subsequent hysterectomy and one primary hemorrhage which required tamponade with Foley catheter. There were three cases of fluid overload with no clinical evidence of fluid over-load syndrome. All five major complications occurred in the first six months or 'learning phase' of the study. During this period, there were proportionately more treatment failures after one attempt (52.8% versus 42.6%) than the second six months of the study. Overall, 53.3% of the patients were satisfied with the initial ablation and 73.3% were satisfied after repeat ablations.

CONCLUSION

Endometrial laser ablation is a major advance in the management of dysfunctional uterine bleeding, especially in patients who would otherwise have had a hysterectomy.