The effectiveness of outpatient Thermachoice endometrial balloon ablation: a long-term 11-year outcome study

Abstract

The aim of this study was to evaluate the long-term treatment outcomes of outpatient Thermachoice balloon endometrial ablation under a direct local anaesthetic cervical block (LA-Thermachoice). This paper is a prospective cohort study and a postal questionnaire survey in a UK teaching hospital with the participation of 253 women with heavy menstrual bleeding (HMB) undergoing LA-Thermachoice over an 11-year period between 2001 and 2011. Treatment success was measured by postoperative bleeding patterns, improvement in dysmenorrhoea, patient satisfaction and post-procedure hysterectomy rates. LA-Thermachoice was completed in 98 % of women. The survey response rate was 78 %. The median follow-up interval was 71 months (SD 42). Seventy-nine percent of the responders reported significant improvement in HMB with 40 % amenorrhoea rate and 86 % improvement in dysmenorrhoea. Eighty-one percent felt that the benefit of procedure was maintained over a long period of time. Eighty-six percent of women were satisfied with the outcome of their procedure. The case notes of nonresponders were examined to check if any had undergone hysterectomy since the LA-Thermachoice procedure. In total, only 16 % of women had a hysterectomy. This study represents the largest published series of local anaesthetic thermal endometrial ablation, reporting clinical outcomes with 11 years (median 71 months) of post-treatment follow-up. It demonstrates that the patient satisfaction with LA-Thermachoice is high, and is maintained over a long period of time after the procedure.

Patient satisfaction and amenorrhea rate after endometrial ablation by ThermaChoice III or NovaSure: a retrospective cohort study

“…Due to the fear of pain, the outpatient setting in ThermaChoice III has not been implemented in many hospitals. [13] Recently Kumar and Gupta demonstrated that ThermaChoice ablation was feasible in an outpatient setting using local anesthesia in a large cohort [14].…”

Local anaesthesia during endometrial ablation: a systematic review

“…[11][12][13]19,20,26,35,37 Nine studies described the use of paracervical anaesthesia 17,18,22,23,27,28,31,32,36 and seven studies described the use of a combination of intracervical, paracervical and/or intrauterine anaesthesia. The ablation techniques that were used include thermal balloon endometrial ablation (TBEA), [11][12][13][17][18][19][20][21][22][23]25,27,[29][30][31]33,36 bipolar radiofrequency endometrial ablation (RFA), 19,20,22,28,32,34,37 hydrothermablation (HTA), 24,38 microwave endometrial ablation (MEA) 35 and hysteroscopic transcervical endometrial resection (T.C.R.E.). The ablation techniques that were used include thermal balloon endometrial ablation (TBEA), [11][12][13]…”

“…11,13,[17][18][19][20][21][22][23][24][25]27,[29][30][31][32][33][34]36,37 Seven of these articles reported a pain score measured during active ablation. These scores described the level of pain during active ablation and/or an 'overall' pain score of the procedure.…”

“…These scores described the level of pain during active ablation and/or an 'overall' pain score of the procedure. Sixteen articles reported an 'overall' pain experience of the procedure, 11,13,[17][18][19][20][21][22]25,27,[29][30][31][32]36,37 which was measured with the VAS in 13 of these articles. 17,21,23,24,30,33,34 Six articles used the visual analogue scale (VAS).…”

“…11,13,[17][18][19][20][21][22][23][24][25]27,[29][30][31][32][33][34]36,37 Seven of these articles reported a pain score measured during active ablation. 11,13,[17][18][19][20][21][22]27,[29][30][31][32] Penninx et al 32 reported a median pain score and from the raw data a mean with standard deviation was calculated. Sixteen articles reported an 'overall' pain experience of the procedure, 11,13,[17][18][19][20][21][22]25,27,[29][30][31][32]36,37 which was measured with the VAS in 13 of these art...…”