Endometrial ablation using SideFire laser fiber.

The first successful use of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser to control hypermenorrhea was reported in 1981. Variations on the technique were attempted to improve the amenorrhea rate. Using the Nd:YAG laser with the blanching or nontouch technique seems to result in a better outcome and higher rate of total amenorrhea than using the dragging technique. Unipolar coagulation attached to a rollerball or rollerbar was also introduced to improve treatment of the sidewalls of the uterus. The unpredictable nature of electrosurgery resulted in varying rates of amenorrhea from as low as 6% and in a subset of patients under 35 years old, to the 70% range in a nonage-adjusted patient population. Due to the report of improved rates of amenorrhea when using the blanching technique and the Nd:YAG laser, a fiber was developed to direct the laser energy at right angles to the axis of the fiber, therefore allowing a total treatment of the entire uterus in a perpendicular fashion. The theoretic benefit of this would be more complete and predictable destruction of the endometrial lining, avoiding fluid overload by coagulating and sealing the vessels and lymphatics. Results in 27 patients in this study seem to support that theory, since 23 patients (86%) experienced total amenorrhea. Mild spotting, requiring no more than a minipad for 3 days, occurred in the other four women. Fluid loss averaged 150 ml with a maximum of 500 ml; six patients had no measurable fluid loss. The age of the patient was not associated with any difference in the final result. The average time of the procedure was 46 minutes, with an average energy use of 89,670 joules. This seems to be a reasonable alternative that offers improved results compared with methods using electrosurgery or the Nd:YAG laser without the SideFire device.