A COMPUTER-CONTROLLED, CONTINUOUSLY CIRCULATING, HOT IRRIGATING SYSTEM FOR ENDOMETRIAL ABLATION

OBJECTIVE: This study evaluated the efficacy of a computer-controlled thermal catheter system to ablate the endometrium by use of 5 to 15 mi of hot saline solution. STUDY DESIGN: Five in vivo sheep uteri and 32 freshly excised human uteri were studied by inserting a self-containe d heater catheter equipped with thermocouples and circulating hot sali ne solution for 15 minutes within the uteri at various temperature set tings ranging from 60 degrees C to 80 degrees C. The uteri were grossl y 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 viabilit y. RESULTS: All 80 degrees C sheep treatments resulted in complete los s of viability at mucosal, submucosal, and myometrial levels. In human uteri temperatures greater than or equal to 80 degrees C produced gro ssly recognizable thermal damage to the endometrium. Full-thickness ir reversible damage was seen in the endometrium. Loss of viability was a lso demonstrated 1 to 3 mm deep in the superficial myometrium. Intraut erine pressure was demonstrated to range from 20 to 40 mm Hg, with a m ean of 26 mm Hg. No leakage of fluid from the oviducts was observed. C ONCLUSION: The data presented here demonstrate that a simple technique coupled with a sophisticated monitoring control system could successf ully ablate the endometrium without the vagaries associated with indiv idual operator skill levels.