A computer-controlled, continuously circulating, hot irrigating system for endometrial ablation

• Published in: American journal of obstetrics and gynecology Vol. 173; no. 6; pp. 1842 - 1848
• Main Authors: Baggish, Michael, Paraiso, Marie, Breznock, E.M, Griffey, Stephen
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.12.1995; Elsevier
• Subjects: Animals; Biological and medical sciences; Catheter Ablation - methods; continuously circulating hot saline solution; Endometrial ablation; Endometrium - surgery; Feasibility Studies; Female; Genital system. Mammary gland; Hot Temperature - therapeutic use; Humans; Medical sciences; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sheep; Sodium Chloride; Therapy, Computer-Assisted; thermal catheter; Endometrial ablation; thermal catheter; continuously circulating hot saline solution; Human; Irrigation; Treatment; Uterus; Animal; Surgery; Instrumentation therapy; Technique; Endometrium
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(95)90438-7

OBJECTIVE: This study evaluated the efficacy of a computer-controlled thermal catheter system to ablate endometrium by use of 5 to 15 ml of hot saline solution. STUDY DESIGN: Five in vivo sheep uteri and 32 freshly excised human uteri were studied by inserting a self-contained heater catheter equipped with thermocouples and circulating hot saline solution for 15 minutes within the uteri at various temperature settings ranging from 60° C to 80° C. The uteri were grossly examined and microscopically evaluated by hematoxylin and eosin and reduced nicotinamide adenine dinucleotide-diaphorase stains for degree of acute destruction, depth of thermal injury, and predicted viability. RESULTS: All 80° C sheep treatments resuled in complete loss of viability at mucosal, submucosal, and myometrial levels. In human uteri temperatures ≥80° C produced grossly recognizable thermal damage to the endometrium. Full-thickness irreversible damage was seen in the endometrium. Loss of viability was also demonstrated 1 to 3 mm deep in the superficial myometrium. Intrauterine pressure was demonstrated to range from 20 to 40 mm Hg, with a mean of 26 mm Hg. No leakage of fluid from the oviducts was observed. CONCLUSION: The data presented here demonstrate that a simple technique coupled with a sophisticated monitoring control system could successfully ablate the endometrium without the vagaries associated with individual operator skill levels.