New techniques for laser ablation of the endometrium in high-risk patients.

Fourteen women underwent endometrial ablation by use of the Nd:YAG laser. All patients had significant risk factors that precluded safe hysterectomy for intractable bleeding. All patients had demonstrated anemia, menorrhagia, and metrorrhagia uncontrolled by hormonal therapy or curettage. Specifically, seven (50%) women in this group had proved major clotting abnormalities as their principal diagnosis. Three new techniques are described as modifications of the original Nd:YAG ablation methodology and include: (1) the use of Hyskon as the uterine distending medium; (2) the attachment of a high-resolution endoscopic television camera to the eyepiece of the hysteroscope, which permits the surgeon to view the endometrial cavity and operate via a video monitor; and (3) the application of a specially designed dual-channel operating hysteroscope that allows simultaneous laser ablation and aspiration of debris. Although this operation is a valuable alternative to hysterectomy in selected clinical situations, its major deficiencies are the lack of long-term follow-up data and the absence of a surgical specimen for pathologic analysis.