Hysteroscopic endometrial ablation or endomyometrial resection (EMR): during endometrial ablation the uterine lining is viewed through a hysteroscope and cauterized with an electrosurgical tip called a "rollerball" or with a laser. It's considered outpatient surgery and normally takes about 20 to 40 minutes. It is performed under general anesthesia and it should take you one to two days to recover, in most cases. Because the uterine lining is destroyed with this procedure, it is not recommended if you want to have children. Endomyometrial resection (EMR) is also a hysteroscopic technique. However, in this procedure the uterine lining and a quarter-inch of its underlying muscle is actually removed. EMR is generally associated with far better outcomes in terms of menstrual blood flow. Its main disadvantage is that it requires considerable technical expertise and should only be performed by highly qualified hysteroscopists.
Hysteroscopic procedures (rollerball and EMR) are acquired skills that and not every physician possesses. Make sure to ask yours about past experience in this procedure before agreeing to it. Rollerball thermal ablation and EMR require that your uterus be filled with fluid so that its contours may be visualized on a monitor. While viewing your uterus, the physician moves the rollerball or wire-loop electrode, which delivers an electrical current, from top to bottom of the uterus until the entire surface of the uterus has been cauterized or removed.
Risks associated with this procedure include uterine perforation, and fluid overload. Because the fluid pumped into your uterus is kept under pressure during the procedure, there is a slight risk that distention fluid may escape into the uterine blood vessels, upsetting the concentration of electrolytes, such as sodium, in your blood stream. This imbalance may be life threatening. However, the risk of fluid overload is rare in the hands of an experienced physician.
Recently approved by the U.S. Food and Drug Administration (FDA) in April 2001, the Hydro ThermAblator® is a computer-controlled device that utilizes a hot saline solution to destroy specific tissue inside the uterus. After the patient has received anesthesia, the doctor inserts a hysteroscope and tubing through the vagina into the uterus. The heater canister, which is located outside the body, heats saline fluid (salt water) to a temperature of 194°F (90°C). With the aid of the pump and valves, the heated fluid is circulated through the HTA system and uterus for 10 minutes. The heated fluid directly contacts the innermost layer of tissue (endometrium) of the uterus. The exposure to heated fluid acts to destroy the endometrium.