Bowel Injury from Nd:YAG Endometrial Ablation

Abstract

Three cases of Nd:YAG laser bowel injury occurring at the time of endometrial ablation are reported. The first incident was due to energy transmission through extremely thin myometrium. Probable fiber perforation of normal myometrium resulted in bowel injury of the second patient. The third case involved heat transmission through a normal myometrium while operating at higher than usual laser power. As the number of Nd:YAG ablations continues to increase, more complications will occur. Steps to ensure its safe application are reviewed. (J GYNECOL SURG 6:

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“…We have shown that in experienced hands or when performed under supervision endometrial laser ablation and transcervical endometrial resection are superior to hysterectomy in terms of intraoperative and postoperative morbidity, the one serious complication being bowel damage similar to that described previously 13. The rate of uterine perforation was low, in contrast with most other reports of endometrial resection,8,12,14,15 which can perhaps be explained by the good uterine preparation achieved by treatment with an analogue of gonadotrophin releasing hormone or by the use of a small diameter loop.…”

A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia

“…Nearly all the perforations were caused by dilators, and none was associated with any intra‐abdominal trauma. Although no perforations were reported during ELA, the presence of a single case of bowel injury similar to others reported in the literature 21 shows that the procedure cannot be considered free of serious risks.…”

Transcervical resection of endometrium and fibroids: The outcome of 412 operations performed over 5 years

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