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Ablation (ablation) of the endometrium is a surgical procedure that is an alternative to curettage of the uterine cavity. The essence of the operation is the complete or occasionally partial removal of the uterine mucosa. During surgery, the integrity of the internal organ is not violated, which contributes to the further resumption of the menstrual cycle. The gynecologist prescribes this manipulation to women only if necessary, if the drugs are not able to defeat the disease.
Features of the method
Ablation of the endometrium (resection or excision) is the complete removal of the uterine mucosa, which is carried out without the use of classical surgical instruments, but with the help of modern painless methods. The advantage of ablation is that the doctor does not need to make additional incisions and other manipulations, access to the endometrium is carried out directly through the cervical canal of the cervix.
During resection, it is necessary to remove the mucosal layer of the uterus: the basal and functional layers with all neoplasms, including pathological and tumor. Quite often, the underlying portion of the muscular membrane is also excised. Doctors resect 3 to 6 millimeters of tissue in thickness.
The removed mucosal layer is not further sent for histological diagnosis, since its cells undergo irreversible destruction during the operation. If the doctor uses an electrical loop, then there is a chance of obtaining tissue samples suitable for laboratory analysis.
Types of endometrial ablation
At the present time, resection is carried out using modern technologies. To remove the inner mucous membrane of the uterus, a contact or non-contact laser light guide (photodynamic therapy), a bipolar electroscalpel (the instrument can be in the form of a ball, barrel, loop, roller) are used. Electroablation with the help of a roller is considered by physicians to be the so-called “gold standard” and is used as a method of therapy for pathological changes in the mucous layer of the uterus.
Other types of ablation include: microwave (microwave exposure to areas of the mucous membrane), cryoablation (liquid nitrogen is pumped into the uterine cavity and manipulation is performed), hydrothermal ablation (as a result of surgical intervention, a contact thermal burn of the uterine mucosa occurs).
The procedure can be carried out using an electrode that will deliver radio frequency waves that cause instantaneous coagulation of mucosal proteins. Treatment of endometrial destruction is also carried out using a hysteroscope, which is inserted into the uterine cavity. The hysteroscope has an attached camera and is a light source, which simplifies the operation.
The most popular treatment for many gynecological diseases, including endometrial destruction, is hysteroresectoscopic mucosal ablation. The technique allows the specialist during the manipulation to assess the condition of the endometrium and control the correctness of the procedure.
Indications and contraindications
The procedure is advisable to carry out with recurrent bleeding from the uterus, which affects women over the age of 35 years. If medical treatment of metrorrhagia fails, it becomes necessary to ablate the endometrium. With recurrent hyperplasticity of the uterine mucosa, which occurs in patients before and during menopause, it is necessary to resort to excision of the mucosal layer.
Quite often, the procedure is prescribed as an alternative to a radical surgical technique, namely hysterectomy. If hormonal treatment is not possible for a woman, the gynecologist recommends resection.
Manipulation contraindications:
- cancer of the mucous layer of the uterus or internal organ;
- suspicion of malignancy of hyperplastic tissues;
- uterine prolapse;
- acute diseases of the genitourinary system;
- sexually transmitted diseases;
- blood clotting disorders.
If the patient has exacerbated chronic diseases or increased body temperature, surgery should be postponed. With endometriosis, ablation is not recommended. If a woman is diagnosed with uterine fibroids, then excision can be performed if the nodes in diameter do not exceed 5 centimeters, and an increase in the internal organ is observed for no more than 3 months.
Ablation
Excision of the uterine mucosa is a surgical intervention, as a result of which the patient must remain hospitalized for 2-3 days. Before the procedure, the patient should be examined by a gynecologist and take tests of urine, blood, blood clotting, smears. The state of the heart and blood vessels is necessarily assessed and the endocrine status is determined. The expediency of taking tests and a complete diagnosis of the body is to exclude oncological pathologies that can cause bleeding and other negative side effects during surgery.
Manipulation is prescribed on the 5th-8th day of the menstrual cycle, since the mucous layer of the organ at this time has the smallest thickness. If the patient has irregular periods or no periods at all, the day of surgery is determined by ultrasound. Often, hormonal drugs are prescribed before the manipulation, they create favorable conditions for the complete excision of the endometrium.
Mucosal resection is performed under general or spinal anesthesia. The patient is located on the gynecological table in a certain position, it is called the Trendelenburg position (the person lies on his back at an inclination of 45 degrees with a raised pelvis) to reduce pressure on the pelvic organs and smooth out the curves of the uterus. In this position, the surgeon has full transvaginal access to the endometrium.
The cervix is fixed with special forceps, then the cervical canal is expanded with a set of Gegar’s instruments. When using a hysteroscope, the doctor conducts a control examination of the uterus. If there is suspicion of malignancy of the sites, it is advisable to do a targeted biopsy. Sometimes it is advisable to use an irrigation system that will create volume in the uterine cavity for the effectiveness and painlessness of the operation.
When the manipulation comes to an end, the patient will be under the supervision of a specialist for 3-4 hours. If a woman has no health complaints, she can be discharged from the hospital on the same day. Doctors are afraid of complications, so they insist on a 2-3-day hospitalization. The maximum duration of hospitalization depends on the complications encountered and the clinical situation in which the patient finds herself.
About the risks and possible complications
The risks of the operation include non-compliance with the methodological technique and the need to use anesthesia. An extremely dangerous complication is perforation of the wall of the internal organ with a catheter or electrode. With hysteroresectoscopic ablation, the risk of perforation is much lower, since the specialist during the operation can control the location of the instrument.
After surgery, the following complications may occur: purulent inflammation in the uterus; profuse bleeding caused by damage to large vessels (bleeding from the uterus after surgery is considered normal for the first 10 days, then you should seek medical help); violation of the functions of adjacent organs (may occur due to heating of the mucous membrane during manipulation); burns of the walls of the vagina and cervical canal (appear as a result of an unobserved technique of surgical intervention).
After the procedure, the lower abdomen may hurt, pull in the lumbar region, feel a little sick, but only for 24 hours after ablation. This symptomatology speaks of an early recovery period and is the body’s response to excision of the endometrium.
Long-term complications after surgery are: obstruction of the cervical canal and synechia. If there is a high risk of synechia, the doctor recommends that the patient install the Mirena coil in the uterus. With the resumption of bleeding from the uterus after 2-3 months, it is worth contacting a gynecologist. This fact may indicate incomplete removal of the endometrium.
Ablation and reproductive health
If a woman wants to have children, ablation will be carried out so that the patient’s menstrual cycle is restored (destruction is completed 1 centimeter above the edge of the internal os of the organ). In this case, menstruation will be restored, but it will be scanty and short.
A patient of reproductive age, agreeing to ablation, does not lose the possibility of conceiving a child. During the manipulation, the ovulatory function of the ovaries is not disturbed, sometimes the doctor can save part of the mucosa, which makes it possible for many women to feel all the delights of motherhood.
Of course, excision of the mucosa can lead to infertility if the specialist neglects the operation or the patient’s body is weakened. That is why the doctor informs about possible risks before the procedure.